Provider Demographics
NPI:1851260038
Name:BOWTIE DENTAL
Entity type:Organization
Organization Name:BOWTIE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:JARQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-224-3319
Mailing Address - Street 1:PO BOX 565005
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-5005
Mailing Address - Country:US
Mailing Address - Phone:305-233-8000
Mailing Address - Fax:305-230-3505
Practice Address - Street 1:12035 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-5234
Practice Address - Country:US
Practice Address - Phone:305-233-8000
Practice Address - Fax:305-230-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty