Individual
MARCUS LOWRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2275 S EAGLE RD STE 100, MERIDIAN, ID 83642-5078
(208) 855-5045
Mailing address
2275 S EAGLE RD STE 100, MERIDIAN, ID 83642-5078
(208) 855-5045
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
57194
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D-3908 OR
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57194
CALIFORNIA DENTAL LICENSE NUMBER
CA
01
—
D-3908-OR
IDAHO DENTAL LICENSE NUMBER
ID
Enumeration date
09/20/2006
Last updated
07/13/2023
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