Provider Demographics
NPI:1962604223
Name:BOWERS, MARC (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:BOWERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 MORAGA AVE
Mailing Address - Street 2:SUITE B206
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5404
Mailing Address - Country:US
Mailing Address - Phone:858-273-0700
Mailing Address - Fax:858-273-7420
Practice Address - Street 1:2706 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7328
Practice Address - Country:US
Practice Address - Phone:337-944-0300
Practice Address - Fax:337-436-5035
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413571223G0001X
LA68251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice