Provider Demographics
NPI:1033484720
Name:JASON W LOWRY DDS PLLC
Entity Type:Organization
Organization Name:JASON W LOWRY DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-753-5069
Mailing Address - Street 1:1730 E BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3500
Mailing Address - Country:US
Mailing Address - Phone:928-753-5069
Mailing Address - Fax:928-753-8115
Practice Address - Street 1:1730 E BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3500
Practice Address - Country:US
Practice Address - Phone:928-753-5069
Practice Address - Fax:928-753-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6171122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6683290001Medicare NSC