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General NPI Number Information
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NPI Number | 1366826323
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Entity Type | Individual
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Provider Name | BROOKE LOWE IGUN DDS
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Gender | Female
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Dates
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Enumeration Date | 07/18/2015
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Last Update Date | 03/20/2022
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Provider Practice Location Address
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Address Line | 1011 E ENNIS AVE STE A
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City | ENNIS
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State | TX
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Zip | 75119-4352
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Country | US
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Telephone | 469-212-1707
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Fax |
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Provider Business Mailing Address
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Address Line | 1707 N HALL ST APT 459
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City | DALLAS
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State | TX
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Zip | 75204-4270
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 31053
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License Number State | TX
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