Provider Demographics
NPI:1255590253
Name:BOWMAN, PETER LUKE (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:LUKE
Last Name:BOWMAN
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:PO BOX 1199
Mailing Address - Street 2:48 MEADOW ACCESS LANE
Mailing Address - City:WALPOLE
Mailing Address - State:NH
Mailing Address - Zip Code:03608-1199
Mailing Address - Country:US
Mailing Address - Phone:603-756-4719
Mailing Address - Fax:
Practice Address - Street 1:48 MEADOW ACCESS LANE
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:NH
Practice Address - Zip Code:03608
Practice Address - Country:US
Practice Address - Phone:603-756-4719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00022761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3096528Medicaid