Provider Demographics
NPI:1235621921
Name:BOWER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BOWER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SKYE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-228-1499
Mailing Address - Street 1:8809 E COUNTY ROAD 600 N
Mailing Address - Street 2:
Mailing Address - City:TWELVE MILE
Mailing Address - State:IN
Mailing Address - Zip Code:46988-9441
Mailing Address - Country:US
Mailing Address - Phone:260-228-1499
Mailing Address - Fax:
Practice Address - Street 1:33 W 7TH ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-2130
Practice Address - Country:US
Practice Address - Phone:765-473-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental