Individual provider Active NPI

Melanie Fowler, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Lafayette, LA
National Provider Identifier
1861421224
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
5402 Issued in LA
Practice address
4906 Ambassador Caffery Pkwy
BLDG O
Lafayette, LA 70508-6916
Phone
(337) 981-4350
Fax
(337) 981-4352
NPI assigned
Jun 30, 2006
Last updated
Jul 10, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 5402 LA Primary

Addresses

Primary practice location

4906 Ambassador Caffery Pkwy
BLDG O
Lafayette, LA 70508-6916

Mailing address

4906 Ambassador Caffery Pkwy
BLDG O
Lafayette, LA 70508-6916
Phone (337) 981-4350

Other identifiers 2

IdentifierTypeStateIssuer
1854026MedicaidLA
43851104030OtherLABLUE CROSS BLUS SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5402LAMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184025600000",
    "number": "1861421224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4906 AMBASSADOR CAFFERY PKWY",
            "address_2": "BLDG O",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086916",
            "telephone_number": "337-981-4350",
            "fax_number": "337-981-4352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4906 AMBASSADOR CAFFERY PKWY",
            "address_2": "BLDG O",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086916",
            "telephone_number": "337-981-4350",
            "fax_number": "337-981-4352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "MELANIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2007-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "LA",
            "license": "5402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1854026",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUS SHIELD",
            "identifier": "43851104030",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; 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.