Healthcare Provider Details

I. General information

NPI: 1851360960
Provider Name (Legal Business Name): JOHN BRUCE LOWE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 CARROLL ST SUITE 5
SHREVEPORT LA
71105-4248
US

IV. Provider business mailing address

230 CARROLL ST SUITE 5
SHREVEPORT LA
71105-4248
US

V. Phone/Fax

Practice location:
  • Phone: 318-868-7127
  • Fax: 318-868-9532
Mailing address:
  • Phone: 318-868-7127
  • Fax: 318-868-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number2594
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: