Active NPI
Jonathan Austin Bowman, DMD
- Dentist
- Indian Trail, NC
National Provider Identifier
1801534904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10173
- Practice address
- 4514 Old Monroe Rd Ste C
Indian Trail, NC 28079-5308 - Phone
- (704) 313-4000
- NPI assigned
- May 26, 2022
- Last updated
- May 29, 2022
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 10173 | SC | Primary |
Addresses
Primary practice location
4514 Old Monroe Rd Ste C
Indian Trail, NC 28079-5308
Mailing address
705 Maple St Apt F101
Columbia, SC 29205-1749
Phone (770) 713-4753
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 |
|---|---|---|---|
| 10173 | SC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653782400000",
"number": "1801534904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 MAPLE ST APT F101",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292051749",
"telephone_number": "770-713-4753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4514 OLD MONROE RD STE C",
"city": "INDIAN TRAIL",
"state": "NC",
"postal_code": "280795308",
"telephone_number": "704-313-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOWMAN",
"first_name": "JONATHAN",
"middle_name": "AUSTIN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-26",
"last_updated": "2022-05-29",
"certification_date": "2022-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "10173",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indian Trail, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.