Provider Demographics
NPI:1629761598
Name:ZHANG, BO WEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BO WEN
Middle Name:
Last Name:ZHANG
Suffix:
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 1:16511 WILD HORSE CREEK RD APT 302
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1436
Mailing Address - Country:US
Mailing Address - Phone:216-333-7466
Mailing Address - Fax:
Practice Address - Street 1:3310 BLUFF CREEK DR STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3582
Practice Address - Country:US
Practice Address - Phone:573-246-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023019554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist