Provider Demographics
NPI:1780020263
Name:LOWE, BETHANY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:LOWE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 RIO BRAVO BLVD SW
Mailing Address - Street 2:SUITE 33
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-6057
Mailing Address - Country:US
Mailing Address - Phone:505-404-9381
Mailing Address - Fax:
Practice Address - Street 1:1625 RIO BRAVO BLVD SW
Practice Address - Street 2:SUITE 33
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-6057
Practice Address - Country:US
Practice Address - Phone:505-404-9381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4533122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist