# JEFFREY W BOWMAN DMD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Grand Teton Denteal Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922269331
- **Authorized official:** DR. JEFFREY WILDAN BOWMAN DMD (OWNER - DENTIST)
- **Authorized official phone:** (208) 787-2323

## Contact information

- **Practice address:** 741 S 50 W, SUITE A, VICTOR, ID 83455-5345
- **Practice address phone:** (208) 787-2323
- **Mailing address:** 741 S 50 W, SUITE A, VICTOR, ID 83455-5345
- **Mailing address phone:** (208) 787-2323

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3162 | ID | Yes |

## Other

- **Enumeration date:** 06/18/2008
- **Last updated:** 06/18/2008