Provider Demographics
NPI:1467157883
Name:RESSLER, BOWEN
Entity Type:Individual
Prefix:
First Name:BOWEN
Middle Name:
Last Name:RESSLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 KAREN AVE UNIT 704
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-0419
Mailing Address - Country:US
Mailing Address - Phone:808-769-1993
Mailing Address - Fax:
Practice Address - Street 1:322 KAREN AVE UNIT 704
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-0419
Practice Address - Country:US
Practice Address - Phone:808-769-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1000X
NV7845122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health