Provider Demographics
NPI:1487918793
Name:LOWEN, KRISTA (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:
Last Name:LOWEN
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 NE 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3558
Mailing Address - Country:US
Mailing Address - Phone:971-645-5241
Mailing Address - Fax:
Practice Address - Street 1:9900 SW GREENBURG RD STE 230
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5473
Practice Address - Country:US
Practice Address - Phone:503-620-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601002821223P0300X
ORD97941223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodontics