Healthcare Provider Details

I. General information

NPI: 1164260055
Provider Name (Legal Business Name): MARK LOWE DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 N FRESNO ST STE 203
FRESNO CA
93720-2957
US

IV. Provider business mailing address

3075 BEACON BLVD
WEST SACRAMENTO CA
95691-3462
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-0966
  • Fax: 559-435-5851
Mailing address:
  • Phone: 916-306-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YASMINE KARAVATTUVEETIL
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 916-306-7576