Provider Demographics
NPI:1093879900
Name:LOWE, LISA DIANE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANE
Last Name:LOWE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FIELDS PRIVATE DR
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TN
Mailing Address - Zip Code:37694-3206
Mailing Address - Country:US
Mailing Address - Phone:423-542-5584
Mailing Address - Fax:
Practice Address - Street 1:1233 SOUTHWEST AVENUE EXTENSION
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6519
Practice Address - Country:US
Practice Address - Phone:423-979-3200
Practice Address - Fax:423-979-3267
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3735124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist