Provider Demographics
NPI:1316159973
Name:CRAIG E. FOWERS,DDS,APC
Entity type:Organization
Organization Name:CRAIG E. FOWERS,DDS,APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:EMERSON
Authorized Official - Last Name:FOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-243-8805
Mailing Address - Street 1:3000 EUREKA WAY
Mailing Address - Street 2:3000 EUREKA WAY
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0184
Mailing Address - Country:US
Mailing Address - Phone:530-243-7120
Mailing Address - Fax:
Practice Address - Street 1:3000 EUREKA WAY
Practice Address - Street 2:3000 EUREKA WAY
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0184
Practice Address - Country:US
Practice Address - Phone:530-243-8805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA022217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty