Healthcare Provider Details

I. General information

NPI: 1326135203
Provider Name (Legal Business Name): LOWELL KAYE ANDERSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W VINE DR LOWELL ANDERSON
TOOELE UT
84074
US

IV. Provider business mailing address

7138 SO 2000 E # 211 DR LOWELL ANDERSON
SALT LAKE CITY UT
84121
US

V. Phone/Fax

Practice location:
  • Phone: 435-882-8800
  • Fax: 435-882-8954
Mailing address:
  • Phone: 801-943-8703
  • Fax: 801-943-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1326469924
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberS246C
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1057
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: