| NPI | 1689221079 |
|---|---|
| Former Legal Business Name | GRANT J FOWLER D.D.S. |
| Entity Type | Organization |
| Authorized Contact | GRANT FOWLER Owner 479-636-2291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2019-08-21 |