Provider Demographics
NPI:1669482345
Name:BOWMAN, TONYA L (DMD)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:L
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1971
Mailing Address - Country:US
Mailing Address - Phone:618-632-2282
Mailing Address - Fax:
Practice Address - Street 1:741 W STATE ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1971
Practice Address - Country:US
Practice Address - Phone:618-632-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice