Provider Demographics
NPI:1619904786
Name:BOWMAN, TERRY ODELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ODELL
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:PO BOX 973
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27239-0973
Mailing Address - Country:US
Mailing Address - Phone:336-859-4581
Mailing Address - Fax:336-859-4582
Practice Address - Street 1:49 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:NC
Practice Address - Zip Code:27239
Practice Address - Country:US
Practice Address - Phone:336-859-4581
Practice Address - Fax:336-859-4582
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89909-16Medicaid