Healthcare Provider Details

I. General information

NPI: 1063636710
Provider Name (Legal Business Name): ERICKA SHELLY LOWE DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICKA FERGUSON DMD, MS

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/18/2023
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 EXECUTIVE PARK CT STE 1600
APOPKA FL
32703-6080
US

IV. Provider business mailing address

660 EXECUTIVE PARK CT STE 1600
APOPKA FL
32703-6080
US

V. Phone/Fax

Practice location:
  • Phone: 407-930-4496
  • Fax: 321-972-2443
Mailing address:
  • Phone: 407-930-4496
  • Fax: 407-930-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17256
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN17256
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: