Individual
COLTON LAWRENCE FOWLKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
880 CANTON RD NE STE 100, MARIETTA, GA 30060-7283
(770) 422-8264
Mailing address
2825 PARNELL SPRINGS CT, CUMMING, GA 30040-5027
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN122221
GA
1223P0221X
Pediatric Dentistry
Primary
DN122221
GA
Other
Enumeration date
01/12/2021
Last updated
02/04/2025
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