Provider Demographics
NPI:1740621606
Name:MICHAEL D BOWEN DDS PC
Entity type:Organization
Organization Name:MICHAEL D BOWEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-687-7378
Mailing Address - Street 1:292 E SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48657-9220
Mailing Address - Country:US
Mailing Address - Phone:989-687-7378
Mailing Address - Fax:989-687-9449
Practice Address - Street 1:292 E SAGINAW RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:MI
Practice Address - Zip Code:48657-9220
Practice Address - Country:US
Practice Address - Phone:989-687-7378
Practice Address - Fax:989-687-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010121071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty