Provider Demographics
NPI:1790481406
Name:FOWLER, SARAH KRISTINE (RDH, OMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KRISTINE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:WA
Mailing Address - Zip Code:99113-9700
Mailing Address - Country:US
Mailing Address - Phone:208-791-7140
Mailing Address - Fax:
Practice Address - Street 1:1114 LAKE ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:WA
Practice Address - Zip Code:99113-9700
Practice Address - Country:US
Practice Address - Phone:208-791-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60179227124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist