Provider Demographics
NPI:1477123883
Name:BOWEN, TYLER JUSTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JUSTIN
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 1:3511 LAKE LUGANO CIR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-4067
Mailing Address - Country:US
Mailing Address - Phone:210-535-7360
Mailing Address - Fax:
Practice Address - Street 1:500 W MONTGOMERY ST STE B
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-8827
Practice Address - Country:US
Practice Address - Phone:936-701-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX373761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice