Kevin James Bowser, DDS
Individual provider Active NPI Dentist · Fort Wayne, IN
NPI 1093380404 · NPPES record last updated Oct 30, 2023
Key facts
- NPI
- 1093380404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 12014057A (IN)
- Practice address
- 2409 Fairoak Dr
Fort Wayne, IN 46809-2301 - Phone
- (260) 747-5745
- NPI assigned
- May 26, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12014057A | IN | MD | Dentist |
| 11549 | TN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bowser Family Dentistry LLC | Current |
Accepting new patients | |
| JSBC Services LLC | Current |
Accepting new patients |
Locations
2409 Fairoak Dr
Fort Wayne, IN 46809
Phone (260) 747-5745
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11549 | TN | |
| Dentist | 122300000X | 12014057A | IN | Yes |
Addresses
Primary practice location
2409 Fairoak Dr
Fort Wayne, IN 46809-2301
Mailing address
330 Bayspring Dr
Fort Wayne, IN 46814-9052
Other practice location 1
3101 S Western Ave
Marion, IN 46953-3966
Phone (765) 662-1022
Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.