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General NPI Number Information
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NPI Number | 1104030121
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Entity Type | Organization
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Legal Business Name | JEFFREY D. FOWLER, D.D.S., M.ED., P.C.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8120 S HOLLY ST #204
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City | CENTENNIAL
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State | CO
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Zip | 80122-4005
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Country | US
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Telephone | 303-771-6969
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Fax | 303-771-1082
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Provider Business Mailing Address
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Address Line | 8120 S HOLLY ST #204
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City | CENTENNIAL
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State | CO
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Zip | 80122-4005
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Country | US
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Telephone | 303-771-6969
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Fax | 303-771-1082
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY DUANE FOWLER
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Credential | D.D.S.
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Telephone | 303-771-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 7725
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License Number State | CO
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