Provider Demographics
NPI:1356432322
Name:LOWENGUTH, JEFFREY B (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:LOWENGUTH
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 1:277 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1019
Mailing Address - Country:US
Mailing Address - Phone:585-924-3240
Mailing Address - Fax:
Practice Address - Street 1:277 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1123
Practice Address - Country:US
Practice Address - Phone:585-924-3240
Practice Address - Fax:585-924-7768
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04538211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY71131VDOtherEXCELLUS BLUE CROSS BLUE SHIELD ROCHESTER, NY