MEDICARE: DR. AUSTIN RICHARD FOWLER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN22687	FL

General Provider Information

NPI Number	:	1225567530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUSTIN RICHARD FOWLER DMD

Provider Business Mailing Address
First Line	:	9776 SAN JOSE BLVD STE 7
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5464
Country	:	US
Telephone Number	:	904-268-6751
Fax Number	:

Provider Business Practice Location Address
First Line	:	9776 SAN JOSE BLVD STE 7
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5464
Country	:	US
Telephone Number	:	904-268-6751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	06/18/2024

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