Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 202787 | CO |
NPI | 1033544937 |
---|---|
Provider Name | Dustin Bowler |
First Address | Englewood, CO 80111-2455 |
Second Address | Wheat Ridge, CO 80033-2339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2013 |
Last Update Date | 05/07/2016 |