Provider Demographics
NPI:1033155262
Name:BOWLING, JAY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:R
Last Name:BOWLING
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 1:652 N GIRLS SCHOOL RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3673
Mailing Address - Country:US
Mailing Address - Phone:317-209-8190
Mailing Address - Fax:317-209-8192
Practice Address - Street 1:652 N GIRLS SCHOOL RD
Practice Address - Street 2:SUITE 115
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3673
Practice Address - Country:US
Practice Address - Phone:317-209-8190
Practice Address - Fax:317-209-8192
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010650A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice