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General NPI Number Information
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NPI Number | 1184634032
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Entity Type | Individual
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Provider Name | MICHAEL PATRICK LOWERY D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5740 GETWELL ROAD BLDG. 10, STE. A
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City | SOUTHAVEN
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State | MS
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Zip | 38672-6347
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Country | US
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Telephone | 662-890-3196
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Fax | 662-890-3197
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Provider Business Mailing Address
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Address Line | 2805 PERSHING CV
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City | SOUTHAVEN
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State | MS
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Zip | 38672-7122
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Country | US
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Telephone | 662-449-2829
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 3300-04
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License Number State | MS
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