Provider Demographics
NPI:1295981330
Name:WILLIAM G. LOW D.D.S. A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:WILLIAM G. LOW D.D.S. A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:D.D.S
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-823-9249
Mailing Address - Street 1:230 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-4384
Mailing Address - Country:US
Mailing Address - Phone:209-823-9249
Mailing Address - Fax:209-823-3390
Practice Address - Street 1:230 CHERRY LN
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-4384
Practice Address - Country:US
Practice Address - Phone:209-823-9249
Practice Address - Fax:209-823-3390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM G. LOW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-08
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty