Healthcare Provider Details

I. General information

NPI: 1255411799
Provider Name (Legal Business Name): LOWELL DENTISTRY FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCAND DR
LOWELL MA
01852-1026
US

IV. Provider business mailing address

75 ARCAND DR
LOWELL MA
01852-1026
US

V. Phone/Fax

Practice location:
  • Phone: 978-323-4399
  • Fax:
Mailing address:
  • Phone: 978-323-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number17094
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10966
License Number StateMA

VIII. Authorized Official

Name: DR. AARON WATMAN
Title or Position: OWNER
Credential: DDS
Phone: 978-323-4399