Fowler Memorial Free Dental Clinic

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FOWLER MEMORIAL FREE DENTAL CLINIC

Practice address

N3150 Highway 81
Suite B-14
Monroe, WI 53566-9397

Phone

(608) 328-9404

NPI assigned

Mar 19, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Annamaria Bliven, M.A.

Title

Clinic Coordinator

Phone

(608) 558-2948

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237420800000",
    "number": "1073754024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N3150 HIGHWAY 81",
            "address_2": "SUITE B-14",
            "city": "MONROE",
            "state": "WI",
            "postal_code": "535669397",
            "telephone_number": "608-328-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N3150 HIGHWAY 81",
            "address_2": "SUITE B-14",
            "city": "MONROE",
            "state": "WI",
            "postal_code": "535669397",
            "telephone_number": "608-328-9404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOWLER MEMORIAL FREE DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-19",
        "last_updated": "2009-03-19",
        "status": "A",
        "authorized_official_last_name": "BLIVEN",
        "authorized_official_first_name": "ANNAMARIA",
        "authorized_official_title_or_position": "CLINIC COORDINATOR",
        "authorized_official_telephone_number": "608-558-2948",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• FMG 26TH Avenue Wisconsin LLC (Monroe Manor Nursing & Rehabilitation)
• Meredith Nicole Foley, OTR/L
• Jaclyn M Foltz, OTR/L
• Kristine E. Fosler, APNP
• Raven Foulker Flannery, APNP
• Steven P Franson
• Michel-Ann Elizabeth Fraser, OD
• Freeport Regional Health Care Foundation (FHN Healthcare Services Monroe)
• Daniel T Frehner, DDS SC
• Terry K Freitag, D.C.

• General Practice Dentistry in Monroe, WI
• Providers in Monroe, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.