Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | WV3636 | WV |
NPI | 1053472696 |
---|---|
Provider Name | Dr. William Craig Bowen |
First Address | Ceredo, WV 25507-0800 |
Second Address | Ceredo, WV 25507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |