Individual provider Active NPI

Michael Scott Fowler, D.M.D., PA.

  • General Practice Dentistry
  • Melbourne, FL
National Provider Identifier
1457544371
Registry record updated Aug 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN14573 Issued in FL
Practice address
38 Suntree PL
Suite 1
Melbourne, FL 32940-7604
Phone
(321) 259-9511
Fax
(321) 255-4644
NPI assigned
Aug 23, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN14573 FL Primary

Addresses

Primary practice location

38 Suntree PL
Suite 1
Melbourne, FL 32940-7604

Mailing address

38 Suntree PL
Suite 1
Melbourne, FL 32940-7604
Phone (321) 259-9511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161029000165 FL Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 0042598849

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
DN14573FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Phillip Estes, DMD, PA Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187827200000",
    "number": "1457544371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 SUNTREE PL",
            "address_2": "SUITE 1",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329407604",
            "telephone_number": "321-259-9511",
            "fax_number": "321-255-4644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 SUNTREE PL",
            "address_2": "SUITE 1",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329407604",
            "telephone_number": "321-259-9511",
            "fax_number": "321-255-4644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.M.D., PA.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-23",
        "last_updated": "2007-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN14573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.