Provider Demographics
NPI:1710985031
Name:LOWE, NELSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:
Last Name:LOWE
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 1:17602 17TH ST
Mailing Address - Street 2:102-258
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1961
Mailing Address - Country:US
Mailing Address - Phone:714-550-7474
Mailing Address - Fax:
Practice Address - Street 1:999 N TUSTIN AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3528
Practice Address - Country:US
Practice Address - Phone:714-550-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363991223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU35004Medicare UPIN