Provider Demographics
NPI:1346408358
Name:BOWERS, JOSEPH HAMPTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HAMPTON
Last Name:BOWERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 EUBANK BLVD NE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3479
Mailing Address - Country:US
Mailing Address - Phone:505-291-9500
Mailing Address - Fax:505-299-8390
Practice Address - Street 1:4550 EUBANK BLVD NE
Practice Address - Street 2:SUITE 207
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3479
Practice Address - Country:US
Practice Address - Phone:505-291-9500
Practice Address - Fax:505-299-8390
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2015-02-03
Deactivation Date:2008-07-17
Deactivation Code:
Reactivation Date:2015-02-03
Provider Licenses
StateLicense IDTaxonomies
NM14961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM26-0149022OtherTAX ID# 26-0149022