Provider Demographics
NPI:1750798252
Name:FOWLER, KARI (DDS)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 G ST
Mailing Address - Street 2:APT H
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-1627
Mailing Address - Country:US
Mailing Address - Phone:808-203-8952
Mailing Address - Fax:
Practice Address - Street 1:4515 FERMI PL
Practice Address - Street 2:SUITE 106
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-9410
Practice Address - Country:US
Practice Address - Phone:530-750-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist