Individual
MELANIE FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4906 AMBASSADOR CAFFERY PKWY, BLDG O, LAFAYETTE, LA 70508-6916
(337) 981-4350
(337) 981-4352
Mailing address
4906 AMBASSADOR CAFFERY PKWY, BLDG O, LAFAYETTE, LA 70508-6916
(337) 981-4350
(337) 981-4352
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
5402
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1854026
—
LA
01
—
43851104030
BLUE CROSS BLUS SHIELD
LA
Enumeration date
06/30/2006
Last updated
07/10/2007
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