Provider Demographics
NPI:1487792982
Name:LOWE, ETHAN ANDREWS (DDS)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:ANDREWS
Last Name:LOWE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 WEST AARON DRIVE
Mailing Address - Street 2:STE 201
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803
Mailing Address - Country:US
Mailing Address - Phone:814-238-4717
Mailing Address - Fax:814-238-4535
Practice Address - Street 1:424 WEST AARON DRIVE
Practice Address - Street 2:STE 201
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803
Practice Address - Country:US
Practice Address - Phone:814-238-4717
Practice Address - Fax:814-238-4535
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist