Provider Demographics
NPI:1780769307
Name:BOWIE, STEPHEN A (DMD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:BOWIE
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 1:109 FLEETWOOD DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-2019
Mailing Address - Country:US
Mailing Address - Phone:864-855-0383
Mailing Address - Fax:864-855-0390
Practice Address - Street 1:109 FLEETWOOD DR
Practice Address - Street 2:SUITE D
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2019
Practice Address - Country:US
Practice Address - Phone:864-855-0383
Practice Address - Fax:864-855-0390
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3518Medicaid
SCZX3518Medicaid