Provider Demographics
NPI:1255574083
Name:FOWLER, ROBERT MARCUS (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARCUS
Last Name:FOWLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ALBERMARLE DR
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-1702
Mailing Address - Country:US
Mailing Address - Phone:864-940-9572
Mailing Address - Fax:
Practice Address - Street 1:124 STRODE CIR
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1484
Practice Address - Country:US
Practice Address - Phone:864-722-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice