Provider Demographics
NPI:1295150126
Name:BOWIE ORTHODONTICS LLC
Entity type:Organization
Organization Name:BOWIE ORTHODONTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-383-0514
Mailing Address - Street 1:6828 RACE TRACK RD STE B
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3042
Mailing Address - Country:US
Mailing Address - Phone:301-383-0514
Mailing Address - Fax:301-383-0517
Practice Address - Street 1:6828 RACE TRACK RD STE B
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3042
Practice Address - Country:US
Practice Address - Phone:301-383-0514
Practice Address - Fax:301-383-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-01
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty