Provider Demographics
NPI:1730368226
Name:BOWERS, JACK ARNOLD (DDS)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:ARNOLD
Last Name:BOWERS
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:HC 63 BOX 57
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:WV
Mailing Address - Zip Code:26815-9501
Mailing Address - Country:US
Mailing Address - Phone:304-358-3886
Mailing Address - Fax:
Practice Address - Street 1:HC 63 BOX 57
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:WV
Practice Address - Zip Code:26815-9501
Practice Address - Country:US
Practice Address - Phone:304-358-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2573122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist