Healthcare Provider Details

I. General information

NPI: 1326376039
Provider Name (Legal Business Name): CLIFFORD LOWDENBACK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CITY HILL DR
LONDON KY
40741-3038
US

IV. Provider business mailing address

200 CITY HILL DR
LONDON KY
40741-3038
US

V. Phone/Fax

Practice location:
  • Phone: 606-877-1900
  • Fax:
Mailing address:
  • Phone: 606-877-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8014
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: