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General NPI Number Information
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NPI Number | 1629408174
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Entity Type | Organization
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Legal Business Name | LOWE DENTAL GROUP AND ASSOCIATES PLLC
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | 6468 TRADING SQ
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City | HAYMARKET
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State | VA
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Zip | 20169-2277
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Country | US
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Telephone | 571-261-2600
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Fax | 571-261-2699
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Provider Business Mailing Address
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Address Line | 6468 TRADING SQ
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City | HAYMARKET
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State | VA
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Zip | 20169-2277
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Country | US
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Telephone | 571-261-2600
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Fax | 571-261-2699
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | DR. TONTRA PETRICE LOWE
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Credential | DDS
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Telephone | 571-261-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401411583
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License Number State | VA
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