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NPI Code Detail

MEDICARE: DR. KRISTA LOWEN DDS, MSD

MEDICARE: DR. KRISTA LOWEN DDS, MSD
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
11223P0300XPeriodonticsDE60100282WA
21223P0300XPeriodonticsD9794OR

General Provider Information

NPI Number : 1487918793
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTA LOWEN DDS, MSD
Provider Business Mailing Address
First Line : 2943 NE 29TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97212-3558
Country : US
Telephone Number : 971-645-5241
Fax Number :
Provider Business Practice Location Address
First Line : 9900 SW GREENBURG RD STE 230
Second Line :
City : TIGARD
State : OR
Zip : 97223-5473
Country : US
Telephone Number : 503-620-1117
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2012
Last Update Date : 04/13/2023

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