Provider Demographics
NPI:1528140670
Name:LOWE, DAVID W (DDS,MS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:LOWE
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 1:4904 S CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-4170
Mailing Address - Country:US
Mailing Address - Phone:386-304-0100
Mailing Address - Fax:386-304-4546
Practice Address - Street 1:4904 S CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-4170
Practice Address - Country:US
Practice Address - Phone:386-304-0100
Practice Address - Fax:386-304-4546
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN138621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics