Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 3764 | OK |
NPI | 1134126980 |
---|---|
Provider Name | Dr. Brandon Royal Bowers |
First Address | Shawnee, OK 74801 |
Second Address | Shawnee, OK 74801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 08/07/2007 |