Healthcare Provider Details

I. General information

NPI: 1144507781
Provider Name (Legal Business Name): DR.S LOWE, NGUYEN & DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4157 S HARVARD AVE STE 119
TULSA OK
74135-2606
US

IV. Provider business mailing address

4157 S HARVARD AVE STE 119
TULSA OK
74135-2606
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-8133
  • Fax: 918-743-3296
Mailing address:
  • Phone: 918-743-8133
  • Fax: 918-743-3296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number4174
License Number StateOK

VIII. Authorized Official

Name: DR. PHILLIP C LOWE
Title or Position: PRESEDENT
Credential: DMD
Phone: 918-743-8133