BOWERS ORTHODONTIC SPECIALISTS NPI 1962789842

NPI Information

NPI: 1962789842
Provider Name: BOWERS ORTHODONTIC SPECIALISTS
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
9 HEARTLAND DR
SUITE A
BLOOMINGTON, IL
ZIP 61704
Phone: (309) 663-0415
Get Directions

BOWERS ORTHODONTIC SPECIALISTS is a dental clinic center in Bloomington, IL. BOWERS ORTHODONTIC SPECIALISTS NPI is 1962789842. The provider is registered as an organization entity type.

The provider's business location address is:

9 HEARTLAND DR
SUITE A
BLOOMINGTON, IL
ZIP 61704-732
Phone: (309) 663-0415
Fax: (309) 661-0685

The provider's authorized official is Kurt T Bowers .
The authorized official title is Owner and has the following contact phone number (309) 663-0415.

The enumeration date for this NPI number is 11/7/2011 and was last updated on 11/7/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental	019.023201	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	021.001647	OTHER	ILLINOIS	ORTHODONTIC LICENSE
2	019013689	MEDICAID	ILLINOIS
3	019.023201	OTHER	ILLINOIS	DENTAL LICENSE
4	37-1312850	OTHER	ILLINOIS	EIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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