Healthcare Provider Details

I. General information

NPI: 1164558649
Provider Name (Legal Business Name): ROBERT B LOWTHORP DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W LINE ST
BISHOP CA
93514-3413
US

IV. Provider business mailing address

350 W LINE ST
BISHOP CA
93514-3413
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-5859
  • Fax: 760-873-5850
Mailing address:
  • Phone: 760-873-5859
  • Fax: 760-873-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22642
License Number StateCA

VIII. Authorized Official

Name: ROBERT B LOWTHORP
Title or Position: PRESIDENT
Credential: DDS
Phone: 760-873-5859