Provider Demographics
NPI:1629408174
Name:LOWE DENTAL GROUP AND ASSOCIATES PLLC
Entity Type:Organization
Organization Name:LOWE DENTAL GROUP AND ASSOCIATES PLLC
Other - Org Name:AWESOME SMILES DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONTRA
Authorized Official - Middle Name:PETRICE
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-261-2600
Mailing Address - Street 1:6468 TRADING SQ
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-2277
Mailing Address - Country:US
Mailing Address - Phone:571-261-2600
Mailing Address - Fax:571-261-2699
Practice Address - Street 1:6468 TRADING SQ
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2277
Practice Address - Country:US
Practice Address - Phone:571-261-2600
Practice Address - Fax:571-261-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty