Provider Demographics
NPI:1659647535
Name:BOWES DENTAL CARE
Entity Type:Organization
Organization Name:BOWES DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:YENNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-697-9900
Mailing Address - Street 1:2375 BOWES DENTAL CARE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-697-9900
Mailing Address - Fax:847-697-9910
Practice Address - Street 1:2375 BOWES DENTAL CARE
Practice Address - Street 2:SUITE #200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-697-9900
Practice Address - Fax:847-697-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-025163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty