NPIMap

Organization Active NPI

Bowers Orthodontic Specialists

  • Dental Clinic/Center
  • Bloomington, IL
National Provider Identifier
1962789842
Registry record updated Nov 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
019.023201 Issued in IL
Legal business name
BOWERS ORTHODONTIC SPECIALISTS
Practice address
9 Heartland Dr
Suite a
Bloomington, IL 61704-7732
Phone
(309) 663-0415
Fax
(309) 661-0685
NPI assigned
Nov 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2011

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

Authorized official

Name
Dr. Kurt T Bowers, D.D.S. M.S.NPI 1639222458
Title
Owner
Phone
(309) 663-0415

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 019.023201 IL Primary

Addresses

Primary practice location

9 Heartland Dr
Suite a
Bloomington, IL 61704-7732

Mailing address

9 Heartland Dr
Suite a
Bloomington, IL 61704-7732
Phone (309) 663-0415

Other identifiers 3

IdentifierTypeStateIssuer
019013689MedicaidIL
021.001647OtherILORTHODONTIC LICENSE
019.023201OtherILDENTAL LICENSE

National Provider Directory

National Provider Directory

Locations

9 Heartland Dr
Ste A
Bloomington, IL 61704
Phone (309) 663-0415

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1320624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320624000000",
    "number": "1962789842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 HEARTLAND DR",
            "address_2": "SUITE A",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047732",
            "telephone_number": "309-663-0415",
            "fax_number": "309-661-0685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 HEARTLAND DR",
            "address_2": "SUITE A",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047732",
            "telephone_number": "309-663-0415",
            "fax_number": "309-661-0685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOWERS ORTHODONTIC SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-07",
        "last_updated": "2011-11-07",
        "status": "A",
        "authorized_official_last_name": "BOWERS",
        "authorized_official_first_name": "KURT",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-663-0415",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S. M.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019.023201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019013689",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORTHODONTIC LICENSE",
            "identifier": "021.001647",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "019.023201",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2011; 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.