Organization
MARK M BOWMAN DDS MSD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK M BOWMAN DDS MSD (PRESIDENT)
(330) 722-6884
Entity
Organization
Contact information
Practice address
803 E WASHINGTON ST, SUITE 100, MEDINA, OH 44256
(330) 722-6884
(330) 722-0575
Mailing address
803 E WASHINGTON ST, SUITE 100, MEDINA, OH 44256
(330) 722-6884
(330) 722-0575
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
20639
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1264120005
OHIO EMPLOYER
OH
Enumeration date
01/22/2007
Last updated
09/18/2007
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