Provider Demographics
NPI:1407984412
Name:FOWLER, KIMBERLYN DARLENE (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLYN
Middle Name:DARLENE
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 1:2040 EAGLE RIDGE DR SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3377
Mailing Address - Country:US
Mailing Address - Phone:470-488-7092
Mailing Address - Fax:470-489-7092
Practice Address - Street 1:2040 EAGLE RIDGE DR SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3377
Practice Address - Country:US
Practice Address - Phone:470-328-2579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0123221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice