Individual
DR. SAMUEL MATTHEW FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
77 NEALY AVE, LANGLEY AFB, VA 23665-2040
(801) 837-6021
Mailing address
1858 S 800 E, BOUNTIFUL, UT 84010-4142
(801) 837-6021
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0401419024
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
PA
Other
Enumeration date
06/25/2015
Last updated
08/12/2024
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