Provider Demographics
NPI:1538193107
Name:BOWMAN, ROBERT G (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
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 1:6650 CROSSING DR.SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508
Mailing Address - Country:US
Mailing Address - Phone:616-554-2100
Mailing Address - Fax:616-554-2104
Practice Address - Street 1:6650 CROSSING DR.SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508
Practice Address - Country:US
Practice Address - Phone:616-554-2100
Practice Address - Fax:616-554-2104
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI011270122300000X
FL7085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7085OtherSTATE DENTAL LICENSE
MI01120OtherSTATE DENTAL LICENSE