Provider Demographics
NPI:1558671743
Name:BOUWENS, DANIEL G (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:G
Last Name:BOUWENS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 MACATAWA DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3163
Mailing Address - Country:US
Mailing Address - Phone:616-538-5920
Mailing Address - Fax:
Practice Address - Street 1:3101 MACATAWA DR SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-3163
Practice Address - Country:US
Practice Address - Phone:616-538-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010197281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics