Provider Demographics
NPI:1013170018
Name:BOWEN, JESSICA ROCHELLE (DMD, MDS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ROCHELLE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ALBANY RD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3516
Mailing Address - Country:US
Mailing Address - Phone:856-495-6105
Mailing Address - Fax:
Practice Address - Street 1:64 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2141
Practice Address - Country:US
Practice Address - Phone:856-596-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0385771223X0400X
NJ22DI024654001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics