Active NPI
Dan O Bowlin, DDS
- General Practice Dentistry
- Tamms, IL
National Provider Identifier
1164410312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019015264
- Practice address
- 405 2ND St
Tamms, IL 62988 - Phone
- (618) 747-2391
- Fax
- (618) 747-2371
- NPI assigned
- Oct 12, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019015264 | IL | Primary |
Addresses
Primary practice location
405 2ND St
Tamms, IL 62988
Mailing address
13245 Kessler Rd
Cairo, IL 62914-3101
Phone (618) 734-4400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019015264 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019015264 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260144000000",
"number": "1164410312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13245 KESSLER RD",
"city": "CAIRO",
"state": "IL",
"postal_code": "629143101",
"telephone_number": "618-734-4400",
"fax_number": "618-734-2884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 2ND ST",
"city": "TAMMS",
"state": "IL",
"postal_code": "62988",
"telephone_number": "618-747-2391",
"fax_number": "618-747-2371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOWLIN",
"first_name": "DAN",
"middle_name": "O",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-12",
"last_updated": "2009-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019015264",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "019015264",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tamms, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.