Provider Demographics
NPI:1376645010
Name:LOWENGUTH, MARK ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:LOWENGUTH
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 1:2024 WEST HENRIETTA RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623
Mailing Address - Country:US
Mailing Address - Phone:585-272-0120
Mailing Address - Fax:585-272-0123
Practice Address - Street 1:2024 WEST HENRIETTA RD
Practice Address - Street 2:SUITE C
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-272-0120
Practice Address - Fax:585-272-0123
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041406011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice