Provider Demographics
NPI:1174190987
Name:LOWE, CODY (DMD)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:
Last Name:LOWE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 SUNSET BEACH CT
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-7613
Mailing Address - Country:US
Mailing Address - Phone:239-331-1733
Mailing Address - Fax:
Practice Address - Street 1:1912 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4700
Practice Address - Country:US
Practice Address - Phone:813-567-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist