| Lake Bowen Dental | |
|
8810 Hwy 9 Inman SC 29349 | |
| (864) 592-1647 | |
| (864) 592-0630 |
| Full Name | Lake Bowen Dental |
|---|---|
| Speciality | Dentist |
| Location | 8810 Hwy 9, Inman, South Carolina |
| Authorized Official Name and Position | Asa Duncan Shirley (DENTIST/OWNER) |
| Authorized Official Contact | 8645921647 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Bowen Dental Po Box 38 Inman SC 29349 Ph: (864) 592-1647 | Lake Bowen Dental 8810 Hwy 9 Inman SC 29349 Ph: (864) 592-1647 |
| NPI Number | 1417053406 |
|---|---|
| Provider Enumeration Date | 09/16/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417053406 | NPI | - | NPPES |
| ZA9600 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | SC1863 (South Carolina) | Primary |
| 122300000X | Dentist | SC1228 (South Carolina) | Secondary |
| 122300000X | Dentist | SC3766 (South Carolina) | Secondary |
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