Provider Demographics
NPI:1467687921
Name:BOWDEN, OGBONNA B (DDS)
Entity Type:Individual
Prefix:DR
First Name:OGBONNA
Middle Name:B
Last Name:BOWDEN
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 1:1502 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-2921
Mailing Address - Country:US
Mailing Address - Phone:773-793-1220
Mailing Address - Fax:
Practice Address - Street 1:1502 E 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2921
Practice Address - Country:US
Practice Address - Phone:773-496-5139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist