Provider Demographics
NPI:1225188899
Name:BOWMAN, TOD C (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOD
Middle Name:C
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MAPLE AVE.
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008
Mailing Address - Country:US
Mailing Address - Phone:760-492-5881
Mailing Address - Fax:760-729-5997
Practice Address - Street 1:2879 HOPE AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1833
Practice Address - Country:US
Practice Address - Phone:760-729-5881
Practice Address - Fax:760-729-5997
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA403371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA848726OtherUNITED CONCORDIA PROVIDER