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General NPI Number Information
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NPI Number | 1053920934
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Entity Type | Individual
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Provider Name | TAIS TREVELIN LOWRY DMD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 15620 VIA MONTECRISTO
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City | SAN DIEGO
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State | CA
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Zip | 92127-4142
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Country | US
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Telephone | 858-679-8918
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Fax |
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Provider Business Mailing Address
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Address Line | 15620 VIA MONTECRISTO
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City | SAN DIEGO
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State | CA
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Zip | 92127-4142
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Country | US
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Telephone | 509-508-7395
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | DDS105858
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS105858
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License Number State | CA
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