Provider Demographics
NPI:1710162557
Name:ANGELIQUE S. COOK-LOWRY DOM, PA
Entity Type:Organization
Organization Name:ANGELIQUE S. COOK-LOWRY DOM, PA
Other - Org Name:HEALTH SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:S
Authorized Official - Last Name:COOK-LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-884-3039
Mailing Address - Street 1:PO BOX 3863
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87190-3863
Mailing Address - Country:US
Mailing Address - Phone:505-884-3039
Mailing Address - Fax:505-898-1438
Practice Address - Street 1:3415 SILVER AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1438
Practice Address - Country:US
Practice Address - Phone:505-884-3039
Practice Address - Fax:505-898-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM116RX171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty