MEDICARE: JEREMY LOUK DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	29707	TX
2	122300000X	Dentist	D4248	ID

General Provider Information

NPI Number	:	1346473402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY LOUK DMD

Provider Business Mailing Address
First Line	:	1 CHISHOLM TRAIL RD STE 3130
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5002
Country	:	US
Telephone Number	:	512-255-9061
Fax Number	:	512-255-1422

Provider Business Practice Location Address
First Line	:	1 CHISHOLM TRAIL RD STE 3130
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5002
Country	:	US
Telephone Number	:	512-255-9061
Fax Number	:	512-255-1422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	03/25/2024

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