Provider Demographics
NPI:1225245699
Name:MCENTIRE, JOHN FOWLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FOWLER
Last Name:MCENTIRE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 ED SCHMIDT BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-5586
Mailing Address - Country:US
Mailing Address - Phone:512-846-1646
Mailing Address - Fax:
Practice Address - Street 1:123 ED SCHMIDT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5586
Practice Address - Country:US
Practice Address - Phone:512-846-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2009-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice