Provider Demographics
NPI:1437126414
Name:BOWLER, MICHAEL WARREN (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WARREN
Last Name:BOWLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 GEORGE WASHINGTON MEM HWY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-2880
Mailing Address - Country:US
Mailing Address - Phone:757-898-1919
Mailing Address - Fax:757-898-2864
Practice Address - Street 1:4310 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2880
Practice Address - Country:US
Practice Address - Phone:757-898-1919
Practice Address - Fax:757-898-2864
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004816122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA002234OtherANTHEM BC/BS
VA468364OtherUNITED CONCORDIA
VA468364OtherUNITED CONCORDIA
VAAB6514093OtherDEA