Provider Demographics
NPI:1912064551
Name:BOWMAN, DAVID C (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:BOWMAN
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 1:306 WALNUT AVE
Mailing Address - Street 2:SUITE #29
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4978
Mailing Address - Country:US
Mailing Address - Phone:619-298-7115
Mailing Address - Fax:619-298-7163
Practice Address - Street 1:306 WALNUT AVE
Practice Address - Street 2:SUITE #29
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4978
Practice Address - Country:US
Practice Address - Phone:619-298-7115
Practice Address - Fax:619-298-7163
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice