Provider Demographics
NPI:1861413924
Name:CHENEY, LOWELL L (DMD)
Entity type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:L
Last Name:CHENEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2401
Mailing Address - Country:US
Mailing Address - Phone:701-852-5333
Mailing Address - Fax:701-852-5130
Practice Address - Street 1:701 3RD ST NE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2401
Practice Address - Country:US
Practice Address - Phone:701-852-5333
Practice Address - Fax:701-852-5130
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND15491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41332Medicaid