Provider Demographics
NPI:1508042235
Name:BOWEN & BOWEN, PLLC
Entity Type:Organization
Organization Name:BOWEN & BOWEN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-587-7495
Mailing Address - Street 1:112 LEE ST W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302
Mailing Address - Country:US
Mailing Address - Phone:304-342-0146
Mailing Address - Fax:304-342-3606
Practice Address - Street 1:112 LEE ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302
Practice Address - Country:US
Practice Address - Phone:304-342-0146
Practice Address - Fax:304-342-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV35701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty