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General NPI Number Information
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NPI Number | 1235390345
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Entity Type | Organization
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Legal Business Name | LOWDER ORTHODONTICS
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Dates
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Enumeration Date | 06/20/2008
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 1410 E 17TH STREET
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City | IDAHO
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State | ID
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Zip | 83403
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Country | US
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Telephone | 208-522-4552
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 E 17TH STREET
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City | IDAHO
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State | ID
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Zip | 83403
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Country | US
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Telephone | 208-522-4552
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. PHILLIP DAVID LOWDER
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Credential | D.D.S. M.CL.D.
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Telephone | 208-569-8980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D3600OR
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License Number State | ID
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