Provider Demographics
NPI:1952438731
Name:LOW, LAWRENCE GLENN (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GLENN
Last Name:LOW
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 1:28669 CARNOUSTIE AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-7009
Mailing Address - Country:US
Mailing Address - Phone:951-485-1071
Mailing Address - Fax:
Practice Address - Street 1:229 CAJON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5201
Practice Address - Country:US
Practice Address - Phone:909-792-9217
Practice Address - Fax:909-798-1779
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice