Provider Demographics
NPI:1780614099
Name:K. DOUGLAS BOWERS, DDS, PA
Entity type:Organization
Organization Name:K. DOUGLAS BOWERS, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-796-2838
Mailing Address - Street 1:151 MARY ESTHER BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1972
Mailing Address - Country:US
Mailing Address - Phone:850-796-2838
Mailing Address - Fax:850-796-3204
Practice Address - Street 1:151 MARY ESTHER BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1972
Practice Address - Country:US
Practice Address - Phone:850-796-2838
Practice Address - Fax:850-796-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN99901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty