Provider Demographics
NPI:1336244243
Name:BOWLES, RYAN G (DDS,MDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:G
Last Name:BOWLES
Suffix:
Gender:M
Credentials:DDS,MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2276 VALLEY VISTA ROAD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932
Mailing Address - Country:US
Mailing Address - Phone:865-518-6288
Mailing Address - Fax:
Practice Address - Street 1:2276 VALLEY VISTA ROAD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932
Practice Address - Country:US
Practice Address - Phone:865-518-6288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN62-090-5318OtherTAX ID NUMBER