Martin Fowler, DMD
Individual provider Active NPI Dentist · Kennett, MO
NPI 1699297481 · NPPES record last updated Jun 13, 2023
Key facts
- NPI
- 1699297481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2017023766 (MO)
- Practice address
- 205 Teaco Rd
Kennett, MO 63857-3236 - Phone
- (573) 888-3521
- NPI assigned
- Jul 13, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017023766 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaverian LLC Dba Kennett Dental Care | Current |
Accepting new patients | |
| Malden Family Dentistry, LLC | Current | Accepting new patients | |
| Burcham Dental Arts Clinic | Past |
Accepting new patients |
Locations
205 Teaco Rd
Kennett, MO 63857
Phone (573) 888-3521
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2017023766 | MO | Yes |
Addresses
Primary practice location
205 Teaco Rd
Kennett, MO 63857-3236
Mailing address
205 Teaco Rd
Kennett, MO 63857-3236
Phone (573) 888-3521
Other providers in Kennett, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.