Individual
MIKKELL MARIE BOWENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2020
Mailing address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2020
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12269255-9923
UT
Other
Enumeration date
08/02/2021
Last updated
08/02/2021
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