Provider Demographics
NPI:1114163326
Name:MICHAEL C BOWMAN DDS PLLC
Entity Type:Organization
Organization Name:MICHAEL C BOWMAN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-752-8888
Mailing Address - Street 1:22 2ND AVE W
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4466
Mailing Address - Country:US
Mailing Address - Phone:406-752-8888
Mailing Address - Fax:
Practice Address - Street 1:22 2ND AVE W
Practice Address - Street 2:SUITE 3000
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4466
Practice Address - Country:US
Practice Address - Phone:406-752-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2258261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental