MEDICARE: SYDNEY 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	DN25435	FL

General Provider Information

NPI Number	:	1962018424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY FOWLER DMD

Provider Business Mailing Address
First Line	:	984 CHAPELTOWN CIR N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-5265
Country	:	US
Telephone Number	:	661-877-7697
Fax Number	:

Provider Business Practice Location Address
First Line	:	12276 SAN JOSE BLVD STE 314
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8632
Country	:	US
Telephone Number	:	661-877-7697
Fax Number	:

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

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	09/21/2020

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Directions to “ SYDNEY FOWLER DMD” Practice Location

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