Provider Demographics
NPI:1003076092
Name:BOWLES FAMILY DENTAL CORP
Entity Type:Organization
Organization Name:BOWLES FAMILY DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SIMMONS
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-772-2114
Mailing Address - Street 1:1520 E LINCOLN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2261
Mailing Address - Country:US
Mailing Address - Phone:714-772-2114
Mailing Address - Fax:714-772-1739
Practice Address - Street 1:1520 E LINCOLN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2261
Practice Address - Country:US
Practice Address - Phone:714-772-2114
Practice Address - Fax:714-772-1739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41818122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty