Healthcare Provider Details

I. General information

NPI: 1871126284
Provider Name (Legal Business Name): LOWES BOULEVARD FAMILY DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LOWES BLVD STE 112
KILLEEN TX
76542-5204
US

IV. Provider business mailing address

5800 N I 35 STE 205
DENTON TX
76207-1438
US

V. Phone/Fax

Practice location:
  • Phone: 940-220-7833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: EVERETT CHAD EVANS
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 940-312-5626