Healthcare Provider Details

I. General information

NPI: 1326062738
Provider Name (Legal Business Name): DR. ROGER A LOWLICHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 MAPLE AVE
NORTH HAVEN CT
06473
US

IV. Provider business mailing address

185 MAPLE AVE
NORTH HAVEN CT
06473
US

V. Phone/Fax

Practice location:
  • Phone: 203-234-8888
  • Fax: 203-234-9489
Mailing address:
  • Phone: 203-234-8888
  • Fax: 203-234-9489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number6330
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: