Provider Demographics
NPI:1093708265
Name:BOWDEN, LARRY (DMD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:BOWDEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17720 JEAN WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5394
Mailing Address - Country:US
Mailing Address - Phone:503-675-7300
Mailing Address - Fax:503-675-7305
Practice Address - Street 1:17720 JEAN WAY
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5394
Practice Address - Country:US
Practice Address - Phone:503-675-7300
Practice Address - Fax:503-675-7305
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
ORD79071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice