Provider Demographics
NPI:1649426461
Name:LOWE, NICHOLAS PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:PAUL
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 1:1367 WILLOW ST APT 353
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2584
Mailing Address - Country:US
Mailing Address - Phone:612-360-5693
Mailing Address - Fax:
Practice Address - Street 1:2125 HEIGHTS DR
Practice Address - Street 2:SUITE 2C
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4562
Practice Address - Country:US
Practice Address - Phone:715-832-5396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND122231223P0300X
WI6407-151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics