Provider Demographics
NPI:1184818569
Name:WILLIAM G.LOW DDS A PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:WILLIAM G.LOW DDS A PROFESSIONAL DENTAL CORP
Other - Org Name:A PROFESSIONAL DENTAL CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:LEMAN
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-465-5747
Mailing Address - Street 1:1341 N EL DORADO ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1016
Mailing Address - Country:US
Mailing Address - Phone:209-465-5747
Mailing Address - Fax:206-465-3602
Practice Address - Street 1:1341 N EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1016
Practice Address - Country:US
Practice Address - Phone:209-465-5747
Practice Address - Fax:206-465-3602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26885-01Medicaid