Provider Demographics
NPI:1144304221
Name:LOWELL FAMILY DENTAL
Entity type:Organization
Organization Name:LOWELL FAMILY DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-770-6400
Mailing Address - Street 1:125 A PRESIDENTIAL DR
Mailing Address - Street 2:
Mailing Address - City:LOWEL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9608
Mailing Address - Country:US
Mailing Address - Phone:479-770-6400
Mailing Address - Fax:479-770-6435
Practice Address - Street 1:125 A PRESIDENTIAL DR
Practice Address - Street 2:
Practice Address - City:LOWEL
Practice Address - State:AR
Practice Address - Zip Code:72745-9608
Practice Address - Country:US
Practice Address - Phone:479-770-6400
Practice Address - Fax:479-770-6435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID NUMBER