Provider Demographics
NPI:1679592695
Name:LOWRY, JASON W (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:W
Last Name:LOWRY
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 1:1730 E BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3500
Mailing Address - Country:US
Mailing Address - Phone:928-753-5069
Mailing Address - Fax:928-753-8115
Practice Address - Street 1:1730 E BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3500
Practice Address - Country:US
Practice Address - Phone:928-753-5069
Practice Address - Fax:928-753-8115
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ61711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice