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General NPI Number Information
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NPI Number | 1659539708
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Entity Type | Organization
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Legal Business Name | SIDNEY J. FOWLER, D.D.S.
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 1023 N MOUND ST SUITE D
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4491
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Country | US
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Telephone | 936-564-9401
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Fax |
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Provider Business Mailing Address
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Address Line | 1023 N MOUND ST SUITE D
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4491
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Country | US
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Telephone | 936-564-9401
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Fax |
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Authorized Official
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Title or Position | OWNER/ OFFICE MANAGER
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Name | MRS. KIM A FOWLER
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Credential | RDH
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Telephone | 936-564-9401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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