Provider Demographics
NPI:1740253509
Name:FOWLER, CRAIG B (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:B
Last Name:FOWLER
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 1:800 ROSE ST RM MN530
Mailing Address - Street 2:UK ORAL PATHOLOGY LAB, UKMC
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0297
Mailing Address - Country:US
Mailing Address - Phone:959-323-5515
Mailing Address - Fax:859-323-2525
Practice Address - Street 1:800 ROSE ST MN530
Practice Address - Street 2:UK ORAL PATHOLOGY LAB, UKMC RM
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0297
Practice Address - Country:US
Practice Address - Phone:959-323-5515
Practice Address - Fax:859-323-2525
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY89801223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100183680Medicaid
KY7100183680Medicaid