Healthcare Provider Details

I. General information

NPI: 1740253509
Provider Name (Legal Business Name): CRAIG B FOWLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST MN530 UK ORAL PATHOLOGY LAB, UKMC RM
LEXINGTON KY
40536-0297
US

IV. Provider business mailing address

800 ROSE ST RM MN530 UK ORAL PATHOLOGY LAB, UKMC
LEXINGTON KY
40536-0297
US

V. Phone/Fax

Practice location:
  • Phone: 959-323-5515
  • Fax: 859-323-2525
Mailing address:
  • Phone: 959-323-5515
  • Fax: 859-323-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number8980
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: