Provider Demographics
NPI:1679686067
Name:BOWLING, HERBERT CHAMPION (DMD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:CHAMPION
Last Name:BOWLING
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:PO BOX 220
Mailing Address - Street 2:297 D SOUTH JACKSON ST.
Mailing Address - City:GROVE HILL
Mailing Address - State:AL
Mailing Address - Zip Code:36451-0220
Mailing Address - Country:US
Mailing Address - Phone:251-275-3611
Mailing Address - Fax:251-275-3622
Practice Address - Street 1:297 D SOUTH JACKSON ST.
Practice Address - Street 2:
Practice Address - City:GROVE HILL
Practice Address - State:AL
Practice Address - Zip Code:36451-0220
Practice Address - Country:US
Practice Address - Phone:251-275-3611
Practice Address - Fax:251-275-3622
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice