Organization
DIAGNOSTIC DENTAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIDNEY JACK FOWLER DDS (OWNER/DENTIST)
(936) 564-9401
Entity
Organization
Contact information
Practice address
1023 N MOUND ST STE D, NACOGDOCHES, TX 75961-4453
(936) 564-9401
(936) 564-3907
Mailing address
1023 N MOUND ST STE D, NACOGDOCHES, TX 75961-4453
(936) 564-9401
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659539708
NPI
TX
Enumeration date
11/03/2025
Last updated
11/03/2025
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