Provider Demographics
NPI:1508947284
Name:BOWDEN, TRACY AUSTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:AUSTIN
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 1:2326 YORK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2266
Mailing Address - Country:US
Mailing Address - Phone:410-828-5699
Mailing Address - Fax:410-828-0711
Practice Address - Street 1:2326 YORK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2266
Practice Address - Country:US
Practice Address - Phone:410-828-5699
Practice Address - Fax:410-828-0711
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD545404200Medicaid