Provider Demographics
NPI:1295830198
Name:BOWLES, RICHARD M (DDSMS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:BOWLES
Suffix:
Gender:M
Credentials:DDSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 CONCORD ST # C
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3304
Mailing Address - Country:US
Mailing Address - Phone:865-546-0792
Mailing Address - Fax:865-546-0877
Practice Address - Street 1:309 CONCORD ST # C
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3304
Practice Address - Country:US
Practice Address - Phone:865-546-0792
Practice Address - Fax:865-546-0877
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics