Provider Demographics
NPI:1598829723
Name:BOWMAN, KENNETH DARRELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DARRELL
Last Name:BOWMAN
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 1:529 A WEST BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-4597
Mailing Address - Country:US
Mailing Address - Phone:540-943-8545
Mailing Address - Fax:
Practice Address - Street 1:529 A WEST BROAD STREET
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-4597
Practice Address - Country:US
Practice Address - Phone:540-943-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA35781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice