Organization
SURFSIDE ORTHODONTICS PA
Active
Organization
SURFSIDE ORTHODONTICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRODIE BOWMAN D.M.D. (OWNER)
(850) 863-2122
Entity
Organization
Contact information
Practice address
28 RACETRACK RD NW, FORT WALTON BEACH, FL 32547-1640
(850) 863-2122
(850) 863-5812
Mailing address
28 RACETRACK RD NW, FORT WALTON BEACH, FL 32547-1640
(850) 863-2122
(850) 863-5812
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
16286
FL
Other
Enumeration date
02/15/2013
Last updated
02/15/2013
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