Basic Information
| Provider Information | |||||||||
| NPI: | 1407836331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOWLER | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | BRIAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5005 N PIEDRAS ST | ||||||||
| Address2: | U.S. ARMY DENTAL ACTIVITY- FT BLISS | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799205001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157426001 | ||||||||
| FaxNumber: | 9155685174 | ||||||||
| Practice Location | |||||||||
| Address1: | 5005 N PIEDRAS ST | ||||||||
| Address2: | U.S. ARMY DENTAL ACTIVITY- FT BLISS | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799205001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157426001 | ||||||||
| FaxNumber: | 9155685174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 06/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0300X | 30-01-8220 | OH | Y | Dental Providers | Dentist | Periodontics | 1223P0300X | DE00008884 | WA | N | Dental Providers | Dentist | Periodontics |
No ID Information.