Provider Demographics
NPI:1205190311
Name:LOWELL, JEREMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:LOWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 JUNIPER HILLS RD
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-9614
Mailing Address - Country:US
Mailing Address - Phone:703-929-3152
Mailing Address - Fax:970-923-0228
Practice Address - Street 1:1280 S UTE AVE
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-2126
Practice Address - Country:US
Practice Address - Phone:970-925-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7565122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist