MEDICARE: DR. CODY LOWE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN25829	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174190987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CODY LOWE DMD

Provider Business Mailing Address
First Line	:	607 SUNSET BEACH CT
Second Line	:
City	:	VALRICO
State	:	FL
Zip	:	33594-7613
Country	:	US
Telephone Number	:	239-331-1733
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 W REYNOLDS ST
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-4700
Country	:	US
Telephone Number	:	813-567-7001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	10/28/2021

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