Provider Demographics
NPI:1740989607
Name:BOWLES, TIMOTHY BERNARD (RDH)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:BERNARD
Last Name:BOWLES
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4695 BONCREST DR E
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6349
Mailing Address - Country:US
Mailing Address - Phone:716-998-1332
Mailing Address - Fax:
Practice Address - Street 1:4695 BONCREST DR E
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6349
Practice Address - Country:US
Practice Address - Phone:716-998-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02239124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist