Provider Demographics
NPI:1538320205
Name:BOWMAN, ROBERT DALE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DALE
Last Name:BOWMAN
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 WEDDINGTON MONROE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:NC
Mailing Address - Zip Code:28104-6273
Mailing Address - Country:US
Mailing Address - Phone:704-612-1313
Mailing Address - Fax:704-973-0682
Practice Address - Street 1:5955 WEDDINGTON MONROE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:NC
Practice Address - Zip Code:28104-6273
Practice Address - Country:US
Practice Address - Phone:704-612-1313
Practice Address - Fax:704-973-0682
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice