Healthcare Provider Details

I. General information

NPI: 1992797641
Provider Name (Legal Business Name): RONALD E. LOWRY M.D., D.D.S., P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N CURTIS RD SUITE 103
BOISE ID
83706-1337
US

IV. Provider business mailing address

1000 N CURTIS RD SUITE 103
BOISE ID
83706-1337
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-1235
  • Fax: 208-323-1236
Mailing address:
  • Phone: 208-323-1235
  • Fax: 208-323-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD1753OS
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberM4194
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: