Individual
DR. BRANDON BOEKAMP FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2015 S EAGLE RD, MERIDIAN, ID 83642-6707
(208) 887-1053
Mailing address
2815 EL RASTRO LN, CARLSBAD, CA 92009-9215
(619) 933-6146
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
57470
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
57470
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D-4813-OR
ID
Other
Enumeration date
08/11/2008
Last updated
12/04/2023
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