Provider Demographics
NPI:1801942149
Name:BOWLING, EVERETT WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:WILLIAM
Last Name:BOWLING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RT 10
Mailing Address - Street 2:EAST PINEVILLE
Mailing Address - City:PINEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:24874-0879
Mailing Address - Country:US
Mailing Address - Phone:304-732-8486
Mailing Address - Fax:304-732-6667
Practice Address - Street 1:RT 10
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:WV
Practice Address - Zip Code:24874-0390
Practice Address - Country:US
Practice Address - Phone:304-732-7567
Practice Address - Fax:304-732-6667
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134758000Medicaid