Provider Demographics
NPI:1114032349
Name:DAVIS, LOWELL BRUCE (DDS, MS)
Entity type:Individual
Prefix:MR
First Name:LOWELL
Middle Name:BRUCE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 SUMMIT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3642
Mailing Address - Country:US
Mailing Address - Phone:510-834-3414
Mailing Address - Fax:510-763-6004
Practice Address - Street 1:2844 SUMMIT ST STE 202
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3642
Practice Address - Country:US
Practice Address - Phone:510-834-3414
Practice Address - Fax:510-763-6004
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260491223P0300X
CA22260491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics