Provider Demographics
NPI:1699980110
Name:FOWLER, JEFFREY DUANE (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DUANE
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 1:8120 SOUTH HOLLY
Mailing Address - Street 2:#204
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-4007
Mailing Address - Country:US
Mailing Address - Phone:303-771-6969
Mailing Address - Fax:303-771-1028
Practice Address - Street 1:8120 S HOLLY ST
Practice Address - Street 2:#204
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-4005
Practice Address - Country:US
Practice Address - Phone:303-771-6969
Practice Address - Fax:303-771-1028
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics