Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 8634 | TN |
NPI | 1053482497 |
---|---|
Provider Name | Dr. Chad Eric Fowler |
First Address | Franklin, TN 37064-2470 |
Second Address | Franklin, TN 37064-2470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 10/09/2007 |