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General NPI Number Information
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NPI Number | 1477709533
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Entity Type | Individual
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Provider Name | TERENCE J FOWLER DDS
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Gender | Male
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 75 W CALLE DE LAS TIENDAS SUITE 150-B
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-4235
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Country | US
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Telephone | 520-393-0006
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Fax | 520-547-3039
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Provider Business Mailing Address
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Address Line | 7109 E BROADWAY BLVD
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City | TUCSON
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State | AZ
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Zip | 85710-1404
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Country | US
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Telephone | 520-319-1390
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Fax | 520-881-5133
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D6034
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License Number State | AZ
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