Provider Demographics
NPI:1063636710
Name:LOWE, ERICKA SHELLY (DMD, MS)
Entity Type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:SHELLY
Last Name:LOWE
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:ERICKA
Other - Middle Name:
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:660 EXECUTIVE PARK CT STE 1600
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6080
Mailing Address - Country:US
Mailing Address - Phone:407-930-4496
Mailing Address - Fax:407-930-4497
Practice Address - Street 1:660 EXECUTIVE PARK CT STE 1600
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6080
Practice Address - Country:US
Practice Address - Phone:407-930-4496
Practice Address - Fax:321-972-2443
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172561223G0001X
FLDN172561223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076768900Medicaid
FL023026500Medicaid