Provider Demographics
NPI:1295837565
Name:BOWMAN, ROGER KENTON (DMD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:KENTON
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 A GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141
Mailing Address - Country:US
Mailing Address - Phone:270-651-8941
Mailing Address - Fax:270-651-8941
Practice Address - Street 1:1010 A GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141
Practice Address - Country:US
Practice Address - Phone:270-651-8941
Practice Address - Fax:270-651-8941
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60044864Medicaid