NPIMap

Organization Active NPI

Mark M Bowman DDS MSD Inc

  • Periodontics
  • Medina, OH
National Provider Identifier
1053465583
Registry record updated Sep 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
20639 Issued in OH
Legal business name
MARK M BOWMAN DDS MSD INC
Practice address
803 E Washington St
Suite 100
Medina, OH 44256
Phone
(330) 722-6884
Fax
(330) 722-0575
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark M Bowman, DDS MSD
Title
President
Phone
(330) 722-6884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 20639 OH Primary

Addresses

Primary practice location

803 E Washington St
Suite 100
Medina, OH 44256

Mailing address

803 E Washington St
Suite 100
Medina, OH 44256
Phone (330) 722-6884

Other identifiers 1

IdentifierTypeStateIssuer
1264120005OtherOHOHIO EMPLOYER

National Provider Directory

National Provider Directory

Locations

803 E Washington St
Ste 100
Medina, OH 44256
Phone (330) 722-6884

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190073600000",
    "number": "1053465583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 E WASHINGTON ST",
            "address_2": "SUITE 100",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "44256",
            "telephone_number": "330-722-6884",
            "fax_number": "330-722-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 E WASHINGTON ST",
            "address_2": "SUITE 100",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "44256",
            "telephone_number": "330-722-6884",
            "fax_number": "330-722-0575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK M BOWMAN DDS MSD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-09-18",
        "status": "A",
        "authorized_official_last_name": "BOWMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-722-6884",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "OH",
            "license": "20639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO EMPLOYER",
            "identifier": "1264120005",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medina, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.