Healthcare Provider Details

I. General information

NPI: 1366684672
Provider Name (Legal Business Name): LOWE & ROSSOPOULOS, D.D.S., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 MAGNOLIA AVE 105
CORONA CA
92879-3104
US

IV. Provider business mailing address

802 MAGNOLIA AVE 105
CORONA CA
92879-3104
US

V. Phone/Fax

Practice location:
  • Phone: 951-371-8833
  • Fax:
Mailing address:
  • Phone: 951-371-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number31027
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number36605
License Number StateCA

VIII. Authorized Official

Name: EVANGELOS ROSSOPOULOS
Title or Position: SECRETARY
Credential:
Phone: 626-854-9530