Provider Demographics
NPI:1669954483
Name:DEREK W. LOWE, DMD, PC
Entity type:Organization
Organization Name:DEREK W. LOWE, DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MATHESON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:907-455-4350
Mailing Address - Street 1:570 RIVERSTONE WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-2939
Mailing Address - Country:US
Mailing Address - Phone:907-455-4350
Mailing Address - Fax:907-455-4370
Practice Address - Street 1:570 RIVERSTONE WAY STE 1
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-2939
Practice Address - Country:US
Practice Address - Phone:907-455-4350
Practice Address - Fax:907-455-4370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1156921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty