1962604223 NPI number — DR. MARC BOWERS D.D.S.

Table of content: DR. MARC BOWERS D.D.S. (NPI 1962604223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962604223 NPI number — DR. MARC BOWERS D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWERS
Provider First Name:
MARC
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962604223
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3737 MORAGA AVE
Provider Second Line Business Mailing Address:
SUITE B206
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92117-5404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-273-0700
Provider Business Mailing Address Fax Number:
858-273-7420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2706 RYAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-7328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-944-0300
Provider Business Practice Location Address Fax Number:
337-436-5035
Provider Enumeration Date:
05/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  41357 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 6825 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)