Provider Demographics
NPI:1356559777
Name:BOWEN, JEFFREY LUCAS (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LUCAS
Last Name:BOWEN
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 1:120 MERIDIAN WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475
Mailing Address - Country:US
Mailing Address - Phone:859-230-2633
Mailing Address - Fax:
Practice Address - Street 1:120 MERIDIAN WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475
Practice Address - Country:US
Practice Address - Phone:859-230-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY84631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry