Provider Demographics
NPI:1255324430
Name:LOWRY, TRACI LYNN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:LYNN
Last Name:LOWRY
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 1:13227 TRIUMPH DR
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2981
Mailing Address - Country:US
Mailing Address - Phone:858-722-2730
Mailing Address - Fax:
Practice Address - Street 1:19871 MITSCHER WAY
Practice Address - Street 2:BRANCH DENTAL CLINIC MIRAMAR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92145-5103
Practice Address - Country:US
Practice Address - Phone:858-577-1825
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18939124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist