Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 061971-01 | NY |
NPI | 1053979450 |
---|---|
Provider Name | Michelle Marie Bowers |
First Address | Brooklyn, NY 11212-3198 |
Second Address | Brooklyn, NY 11212-3198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2019 |
Last Update Date | 18/11/2021 |