Provider Demographics
NPI:1760575724
Name:JIM BOWDEN DDS PA
Entity Type:Organization
Organization Name:JIM BOWDEN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-585-6373
Mailing Address - Street 1:7185 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1748
Mailing Address - Country:US
Mailing Address - Phone:915-585-6373
Mailing Address - Fax:915-585-6372
Practice Address - Street 1:7185 WESTWIND DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1748
Practice Address - Country:US
Practice Address - Phone:915-585-6373
Practice Address - Fax:915-585-6372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140241223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX825442OtherUNITED CONCORDIA PROVIDER