Most Relevant Information
Provider Data
| NPI Number: | 1003466095 |
| Provider Name: | DYLAN LEE BOWERSOX |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: | RTO000232 |
Most Important Dates
| Enumeration Date: | 09/12/2019 |
| Last Updated: | 09/12/2019 |
Provider Practice Location
2380 WILDWOOD RD
MIFFLINBURG
PA
178448250
Practice Location Phone/Fax
| Phone: | 5704285047 |
| Fax: |
Provider Mailing Location
2380 WILDWOOD RD
MIFFLINBURG
PA
178448250
Provider Mailing Phone/Fax
| Phone: | 5704285047 |
| Fax: |