Jeremy Lee Bowen, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2007014390 Issued in MO

Practice address

19201 E Valley View Pkwy
Suite a
Independence, MO 64055-6910

Phone

(816) 478-3600

Fax

(816) 478-0246

NPI assigned

May 30, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 1, 2007 through Nov 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Opdahl & Bowen DDS PC

  • Dentist
  • Independence, MO
  • NPI 1790895043
  NPD (past)

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285804800000",
    "number": "1386845188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19201 E VALLEY VIEW PKWY",
            "address_2": "SUITE A",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640556910",
            "telephone_number": "816-478-3600",
            "fax_number": "816-478-0246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19201 E VALLEY VIEW PKWY",
            "address_2": "SUITE A",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640556910",
            "telephone_number": "816-478-3600",
            "fax_number": "816-478-0246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOWEN",
        "first_name": "JEREMY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-30",
        "last_updated": "2010-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2007014390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Borr
• Robert Ryan Borsheski, D.O.
• Tonishia Boston
• Deambra Lea Boucher, O.D.
• Margaret Boucher
• Johnathan Michael Bowen, DPT
• Dylan Timothy Bowling, PTA
• Donnie Ray Bowman Jr., PHARMD
• Lori Lynne Boyd
• Sydney Boyd

• General Practice Dentistry in Independence, MO
• Providers in Independence, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.