Provider Demographics
NPI:1245721109
Name:BOWER, SKYE (DDS)
Entity type:Individual
Prefix:DR
First Name:SKYE
Middle Name:
Last Name:BOWER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8809 E COUNTY ROAD 600 N
Mailing Address - Street 2:
Mailing Address - City:TWELVE MILE
Mailing Address - State:IN
Mailing Address - Zip Code:46988-9441
Mailing Address - Country:US
Mailing Address - Phone:260-228-1499
Mailing Address - Fax:
Practice Address - Street 1:33 W 7TH ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970
Practice Address - Country:US
Practice Address - Phone:765-473-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012929A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist