Organization
BOWERS ORTHODONTIC SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KURT T BOWERS D.D.S. M.S. (OWNER)
(309) 663-0415
Entity
Organization
Contact information
Practice address
9 HEARTLAND DR, SUITE A, BLOOMINGTON, IL 61704-7732
(309) 663-0415
(309) 661-0685
Mailing address
9 HEARTLAND DR, SUITE A, BLOOMINGTON, IL 61704-7732
(309) 663-0415
(309) 661-0685
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019.023201
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019.023201
DENTAL LICENSE
IL
05
—
019013689
—
IL
01
—
021.001647
ORTHODONTIC LICENSE
IL
Enumeration date
11/07/2011
Last updated
11/07/2011
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