Provider Demographics
NPI:1922216720
Name:BOWLER, KRISTA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:
Last Name:BOWLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21204 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2813
Mailing Address - Country:US
Mailing Address - Phone:718-423-7009
Mailing Address - Fax:718-225-1516
Practice Address - Street 1:21204 42ND AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2813
Practice Address - Country:US
Practice Address - Phone:718-423-7009
Practice Address - Fax:718-225-1516
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019323-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist