Provider Demographics
NPI:1386845188
Name:BOWEN, JEREMY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:LEE
Last Name:BOWEN
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 1:19201 E VALLEY VIEW PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6910
Mailing Address - Country:US
Mailing Address - Phone:816-478-3600
Mailing Address - Fax:816-478-0246
Practice Address - Street 1:19201 E VALLEY VIEW PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6910
Practice Address - Country:US
Practice Address - Phone:816-478-3600
Practice Address - Fax:816-478-0246
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070143901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice