Provider Demographics
NPI:1104030121
Name:JEFFREY D. FOWLER, D.D.S., M.ED., P.C.
Entity Type:Organization
Organization Name:JEFFREY D. FOWLER, D.D.S., M.ED., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-771-6969
Mailing Address - Street 1:8120 S HOLLY ST
Mailing Address - Street 2:#204
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-4005
Mailing Address - Country:US
Mailing Address - Phone:303-771-6969
Mailing Address - Fax:303-771-1082
Practice Address - Street 1:8120 S HOLLY ST
Practice Address - Street 2:#204
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-4005
Practice Address - Country:US
Practice Address - Phone:303-771-6969
Practice Address - Fax:303-771-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========OtherDELTA DENTAL