Provider Demographics
NPI:1457439978
Name:BOWER, PETER J (DMD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:BOWER
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 1:701 W HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1937
Mailing Address - Country:US
Mailing Address - Phone:928-541-9000
Mailing Address - Fax:928-541-0975
Practice Address - Street 1:701 W HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1937
Practice Address - Country:US
Practice Address - Phone:928-541-9000
Practice Address - Fax:928-541-0975
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist