Provider Demographics
NPI:1811479975
Name:MIDWEST CITY FAMILY DENTISTRY
Entity type:Organization
Organization Name:MIDWEST CITY FAMILY DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-326-8004
Mailing Address - Street 1:9060 HARMONY DR STE D
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-6253
Mailing Address - Country:US
Mailing Address - Phone:405-737-8831
Mailing Address - Fax:
Practice Address - Street 1:9060 HARMONY DR STE D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6253
Practice Address - Country:US
Practice Address - Phone:405-737-8831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6076261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental