Provider Demographics
NPI:1679937551
Name:LOWRY FAMILY DENTAL PRACTICE
Entity Type:Organization
Organization Name:LOWRY FAMILY DENTAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:FANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-364-6659
Mailing Address - Street 1:200 QUEBEC ST
Mailing Address - Street 2:BLDG 500, UNIT 105
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7144
Mailing Address - Country:US
Mailing Address - Phone:303-364-6659
Mailing Address - Fax:
Practice Address - Street 1:200 QUEBEC ST
Practice Address - Street 2:BLDG 500, UNIT 105
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7144
Practice Address - Country:US
Practice Address - Phone:303-364-6659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7020OtherLICENSE