Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 24474 | CA |
NPI | 1013042688 |
---|---|
Provider Name | Dr. Everett L. Low |
First Address | Stockton, CA 95202-1016 |
Second Address | Manteca, CA 95336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |