Provider Demographics
NPI:1124219613
Name:J&L BOWMAN CORP
Entity Type:Organization
Organization Name:J&L BOWMAN CORP
Other - Org Name:ATLANTIC DENTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-631-3155
Mailing Address - Street 1:888 SOUTH U.S. HWY #1
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2126
Mailing Address - Country:US
Mailing Address - Phone:321-631-3155
Mailing Address - Fax:631-638-8684
Practice Address - Street 1:888 SOUTH U.S. HWY #1
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2126
Practice Address - Country:US
Practice Address - Phone:321-631-3155
Practice Address - Fax:631-638-8684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental