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Organization
BLUE CEDAR DENTISTRY LLC
Active
Organization
BLUE CEDAR DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN BOWEN DMD (OWNER)
(702) 283-8421
Entity
Organization
Contact information
Practice address
121 N MAIN AVE, BOLIVAR, MO 65613-1517
(702) 283-8421
Mailing address
121 N MAIN AVE, BOLIVAR, MO 65613-1517
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
06/05/2021
Last updated
06/07/2021
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