Provider Demographics
NPI:1366699605
Name:BOWERS, LEAH (DMD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:
Last Name:BOWERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 NORTH JEFFERSON STREET
Mailing Address - Street 2:APT. F12
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202
Mailing Address - Country:US
Mailing Address - Phone:601-750-0690
Mailing Address - Fax:
Practice Address - Street 1:731 N JEFFERSON ST
Practice Address - Street 2:APT. F12
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-3129
Practice Address - Country:US
Practice Address - Phone:601-750-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ5927390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program