Provider Demographics
NPI:1609235845
Name:FOWLIE, JAMES JAY (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JAY
Last Name:FOWLIE
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 1:16191 KAMANA RD
Mailing Address - Street 2:#102
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-0834
Mailing Address - Country:US
Mailing Address - Phone:760-242-7744
Mailing Address - Fax:760-242-1833
Practice Address - Street 1:16191 KAMANA RD
Practice Address - Street 2:#102
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-0834
Practice Address - Country:US
Practice Address - Phone:760-242-7744
Practice Address - Fax:760-242-1833
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice