Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 22DI02465400 | NJ |
N | 1223X0400X | Orthodontists | DS038577 | PA |
NPI | 1013170018 |
---|---|
Provider Name | Dr. Jessica Rochelle Bowen |
First Address | Marlton, NJ 08053-3516 |
Second Address | Marlton, NJ 08053-2141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 01/11/2019 |