Healthcare Provider Details

I. General information

NPI: 1710162557
Provider Name (Legal Business Name): ANGELIQUE S. COOK-LOWRY DOM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 SILVER AVE SE
ALBUQUERQUE NM
87106-1438
US

IV. Provider business mailing address

PO BOX 3863
ALBUQUERQUE NM
87190-3863
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-3039
  • Fax: 505-898-1438
Mailing address:
  • Phone: 505-884-3039
  • Fax: 505-898-1438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number116RX
License Number StateNM

VIII. Authorized Official

Name: DR. ANGELIQUE S COOK-LOWRY
Title or Position: PRESIDENT
Credential: D.O.M.
Phone: 505-884-3039