1962804534 NPI number — DR. AKINTUNDE ANAN BOWDEN D.D.S.

Table of content: DR. AKINTUNDE ANAN BOWDEN D.D.S. (NPI 1962804534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962804534 NPI number — DR. AKINTUNDE ANAN BOWDEN D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWDEN
Provider First Name:
AKINTUNDE
Provider Middle Name:
ANAN
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:
1962804534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2555 N. MARTIN LUTHER KING JR. DRIVE
Provider Second Line Business Mailing Address:
MILWAUKEE HEALTH SERVICES, INC.
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53212-2709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-267-2670
Provider Business Mailing Address Fax Number:
414-562-8432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2555 N DR MARTIN LUTHER KING JR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53212-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-372-8080
Provider Business Practice Location Address Fax Number:
414-562-8432
Provider Enumeration Date:
09/25/2014

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:  1001000-15 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100040538 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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