Healthcare Provider Details

I. General information

NPI: 1053482497
Provider Name (Legal Business Name): CHAD ERIC FOWLER D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 NEW HIGHWAY 96 W SUITE 203
FRANKLIN TN
37064-2470
US

IV. Provider business mailing address

511 NEW HIGHWAY 96 W SUITE 203
FRANKLIN TN
37064-2470
US

V. Phone/Fax

Practice location:
  • Phone: 615-591-4770
  • Fax:
Mailing address:
  • Phone: 615-591-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8634
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: