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General NPI Number Information
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NPI Number | 1093879900
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Entity Type | Individual
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Provider Name | LISA DIANE LOWE RDH
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Gender | Female
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1233 SOUTHWEST AVENUE EXTENSION
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City | JOHNSON CITY
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State | TN
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Zip | 37604-6519
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Country | US
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Telephone | 423-979-3200
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Fax | 423-979-3267
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Provider Business Mailing Address
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Address Line | 115 FIELDS PRIVATE DR
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City | WATAUGA
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State | TN
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Zip | 37694-3206
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Country | US
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Telephone | 423-542-5584
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 3735
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License Number State | TN
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