Fowler, Sidney Jack

Fowler, Sidney Jack is an sole proprietor health care provider with primary practice located at 1023 N Mound St Suite D, Nacogdoches TX 75961-4491. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Fowler, Sidney Jack can be contacted via phone (936) 564-9401.

Contact Information

Primary practice address
1023 N Mound St Suite D Nacogdoches TX 75961-4491
Phone: (936) 564-9401
Fax: (936) 564-3907
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 11803 Texas

Profile Details

NPI number 1982779195
LBN Legal business name Fowler, Sidney Jack
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 22nd, 2006
Last updated Jul 20th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982779195 NPPES
Texas MEDICAID 120750805
Texas MEDICAID 172282901
Texas Other G60111-01

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