Provider Demographics
NPI:1417228503
Name:ROGER A. LOWLICHT DDS,PC
Entity Type:Organization
Organization Name:ROGER A. LOWLICHT DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOWLICHT
Authorized Official - Suffix:
Authorized Official - Credentials:MS,DDS
Authorized Official - Phone:203-234-8888
Mailing Address - Street 1:185 MAPLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473
Mailing Address - Country:US
Mailing Address - Phone:203-234-8888
Mailing Address - Fax:203-234-9489
Practice Address - Street 1:185 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3324
Practice Address - Country:US
Practice Address - Phone:203-234-8888
Practice Address - Fax:203-234-9489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20633031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT190000607OtherMEDICARE ID