Provider Demographics
NPI:1417235235
Name:HAVRON, JESS FOWLER (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JESS
Middle Name:FOWLER
Last Name:HAVRON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8154 HIGHWAY 59
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535
Mailing Address - Country:US
Mailing Address - Phone:251-923-4445
Mailing Address - Fax:251-923-4446
Practice Address - Street 1:8154 HIGHWAY 59
Practice Address - Street 2:SUITE 203
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-923-4445
Practice Address - Fax:251-923-4446
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL56821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics