Provider Demographics
NPI:1437223120
Name:LOWDEN DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:LOWDEN DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SAMUELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-941-5281
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:305 MCKINLEY AVE
Mailing Address - City:LOWDEN
Mailing Address - State:IA
Mailing Address - Zip Code:52255
Mailing Address - Country:US
Mailing Address - Phone:563-941-5281
Mailing Address - Fax:563-941-5218
Practice Address - Street 1:305 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:LOWDEN
Practice Address - State:IA
Practice Address - Zip Code:52255
Practice Address - Country:US
Practice Address - Phone:563-941-5281
Practice Address - Fax:563-941-5218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA58221223G0001X
IA60411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1098418Medicaid
IA1075945Medicaid
IA1075945Medicaid
IA1098418Medicaid