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General NPI Number Information
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NPI Number | 1548429434
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Entity Type | Organization
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Legal Business Name | MATTHEW A. FOWLER, D.M.D., P.C.
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 347 W IOWA AVE
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City | NAMPA
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State | ID
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Zip | 83686-2856
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Country | US
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Telephone | 208-468-9699
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Fax | 208-461-9024
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Provider Business Mailing Address
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Address Line | 347 W IOWA AVE
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City | NAMPA
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State | ID
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Zip | 83686-2856
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Country | US
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Telephone | 208-468-9699
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Fax | 208-461-9024
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW A FOWLER
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Credential | D.M.D., M.S.
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Telephone | 208-468-9699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D3264EN
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License Number State | ID
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