Provider Demographics
NPI:1699022285
Name:FOWLER, ANDREA (RDH)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 CHRISTIAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-3210
Mailing Address - Country:US
Mailing Address - Phone:207-667-0293
Mailing Address - Fax:207-667-5805
Practice Address - Street 1:52 CHRISTIAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3210
Practice Address - Country:US
Practice Address - Phone:207-667-0293
Practice Address - Fax:207-667-5805
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH3712124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist