Provider Demographics
NPI:1396846234
Name:LOWE, GREG WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:WILLIAM
Last Name:LOWE
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 1:622 E. WASHINGTON AVE.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MI
Mailing Address - Zip Code:48880
Mailing Address - Country:US
Mailing Address - Phone:989-681-3050
Mailing Address - Fax:
Practice Address - Street 1:622 E. WASHINGTON AVE.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880
Practice Address - Country:US
Practice Address - Phone:989-681-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010134821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice