MEDICARE: MRS. TRACI LYNN LOWRY RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	18939	CA

General Provider Information

NPI Number	:	1255324430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACI LYNN LOWRY RDH

Provider Business Mailing Address
First Line	:	13227 TRIUMPH DR
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-2981
Country	:	US
Telephone Number	:	858-722-2730
Fax Number	:

Provider Business Practice Location Address
First Line	:	19871 MITSCHER WAY
Second Line	:	BRANCH DENTAL CLINIC MIRAMAR
City	:	SAN DIEGO
State	:	CA
Zip	:	92145-5103
Country	:	US
Telephone Number	:	858-577-1825
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/08/2007

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