Provider Demographics
NPI:1942023171
Name:LOWELL, ROSE (RDHEP)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:LOWELL
Suffix:
Gender:F
Credentials:RDHEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-0713
Mailing Address - Country:US
Mailing Address - Phone:541-729-1932
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 713
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-0713
Practice Address - Country:US
Practice Address - Phone:541-729-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5414124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist