Provider Demographics
NPI:1851360960
Name:LOWE, JOHN BRUCE (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRUCE
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 1:230 CARROLL ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4248
Mailing Address - Country:US
Mailing Address - Phone:318-868-7127
Mailing Address - Fax:318-868-9532
Practice Address - Street 1:230 CARROLL ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4248
Practice Address - Country:US
Practice Address - Phone:318-868-7127
Practice Address - Fax:318-868-9532
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA25941223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA58273Medicare ID - Type Unspecified
T19837Medicare UPIN