Provider Demographics
NPI:1326410218
Name:LEA H FOWLER DMD PSC
Entity Type:Organization
Organization Name:LEA H FOWLER DMD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEA
Authorized Official - Middle Name:H
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-839-0121
Mailing Address - Street 1:147 W WOODFORD ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-1100
Mailing Address - Country:US
Mailing Address - Phone:502-839-0121
Mailing Address - Fax:502-839-1607
Practice Address - Street 1:147 W WOODFORD ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1100
Practice Address - Country:US
Practice Address - Phone:502-839-0121
Practice Address - Fax:502-839-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty