Provider Demographics
NPI:1891437596
Name:BOWERS, ANDREW FORREST
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:FORREST
Last Name:BOWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 COORS BLVD NW STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6468
Mailing Address - Country:US
Mailing Address - Phone:505-219-0482
Mailing Address - Fax:505-219-0482
Practice Address - Street 1:10010 COORS BLVD NW STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6468
Practice Address - Country:US
Practice Address - Phone:505-219-0482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL575221223G0001X
NMDB-2023-01031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice