Provider Demographics
NPI:1083768006
Name:O G BOWSER DMD LTD
Entity Type:Organization
Organization Name:O G BOWSER DMD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:O
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOWSER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-763-3651
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:939 FOURTH AVENUE
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-0208
Mailing Address - Country:US
Mailing Address - Phone:724-763-3651
Mailing Address - Fax:724-763-2634
Practice Address - Street 1:939 FOURTH AVENUE
Practice Address - Street 2:
Practice Address - City:FORD CITY
Practice Address - State:PA
Practice Address - Zip Code:16226-0208
Practice Address - Country:US
Practice Address - Phone:724-763-3651
Practice Address - Fax:724-763-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS015328L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty