Provider Demographics
NPI:1558372276
Name:BOWERS, JAMES EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:BOWERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2950 LOCH LOMOND DR
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6859
Mailing Address - Country:US
Mailing Address - Phone:770-321-6111
Mailing Address - Fax:770-496-4553
Practice Address - Street 1:4001 CANTON RD STE 1
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2998
Practice Address - Country:US
Practice Address - Phone:770-591-3832
Practice Address - Fax:770-591-4210
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0092271223G0001X
GA92271223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics