Provider Demographics
NPI:1972722353
Name:BOWMAN, TODD ALAN SR (DMD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ALAN
Last Name:BOWMAN
Suffix:SR
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 1:3485 W 5200 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-9438
Mailing Address - Country:US
Mailing Address - Phone:435-633-7066
Mailing Address - Fax:202-836-6921
Practice Address - Street 1:3444 S 5600 W
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-1320
Practice Address - Country:US
Practice Address - Phone:801-964-0444
Practice Address - Fax:801-963-1270
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1428301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice