Provider Demographics
NPI:1922361104
Name:EL RENO DENTAL
Entity Type:Organization
Organization Name:EL RENO DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-262-1919
Mailing Address - Street 1:2005 PARKVIEW DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2150
Mailing Address - Country:US
Mailing Address - Phone:405-262-1919
Mailing Address - Fax:
Practice Address - Street 1:2005 PARKVIEW DR
Practice Address - Street 2:SUITE 2
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2150
Practice Address - Country:US
Practice Address - Phone:405-262-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty