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General NPI Number Information
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NPI Number | 1710304415
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Entity Type | Organization
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Legal Business Name | FOWLER FAMILY PRACTICE
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 03/20/2014
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Provider Practice Location Address
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Address Line | 9745 FAIRWAY BLVD
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City | POWELL
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State | OH
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Zip | 43065-6947
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Country | US
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Telephone | 614-766-5722
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Fax |
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Provider Business Mailing Address
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Address Line | 9745 FAIRWAY BLVD
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City | POWELL
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State | OH
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Zip | 43065-6947
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Country | US
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Telephone | 614-766-5722
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Fax |
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Authorized Official
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Title or Position | CREDENTIAL MANAGER
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Name | KATHY DOTSON
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Credential |
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Telephone | 614-441-9212
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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 | 30023906
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License Number State | OH
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