Provider Demographics
NPI:1972081313
Name:BOWIE ORAL AND FACIAL SURGERY CENTER INC.
Entity type:Organization
Organization Name:BOWIE ORAL AND FACIAL SURGERY CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NKEMAKONAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EGOLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-460-0635
Mailing Address - Street 1:4175 N HANSON CT STE 200
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3180
Mailing Address - Country:US
Mailing Address - Phone:301-383-9883
Mailing Address - Fax:301-349-1447
Practice Address - Street 1:4175 N HANSON CT STE 200
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716
Practice Address - Country:US
Practice Address - Phone:301-760-4660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-28
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD162041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty