Provider Demographics
NPI:1730515602
Name:BOWERS, K. DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:K.
Middle Name:DOUGLAS
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 1:151 MARY ESTHER BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1972
Mailing Address - Country:US
Mailing Address - Phone:850-796-2838
Mailing Address - Fax:850-796-3204
Practice Address - Street 1:151 MARY ESTHER BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1972
Practice Address - Country:US
Practice Address - Phone:850-796-2838
Practice Address - Fax:850-796-3204
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN99901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice