Provider Demographics
NPI:1114446564
Name:BOWEN, DOUGLAS YALE (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:YALE
Last Name:BOWEN
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 S. CHUGACH ST.
Mailing Address - Street 2:STE. #2
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-745-5337
Mailing Address - Fax:907-745-5338
Practice Address - Street 1:809 S. CHUGACH ST.
Practice Address - Street 2:STE. #2
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-745-5337
Practice Address - Fax:907-745-5338
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL-455-17122300000X
AK1490051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist