Provider Demographics
NPI:1336291723
Name:BOWEN, ELMO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELMO
Middle Name:
Last Name:BOWEN
Suffix:JR
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 1:3500 GROVE AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2220
Mailing Address - Country:US
Mailing Address - Phone:804-359-6087
Mailing Address - Fax:804-359-6088
Practice Address - Street 1:3500 GROVE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2220
Practice Address - Country:US
Practice Address - Phone:804-359-6087
Practice Address - Fax:804-359-6088
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist