MEDICARE: DR. MICHAEL STEVEN LOUIE DDS

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	DDS105088	CA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	105088	CA

General Provider Information

NPI Number	:	1659981447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL STEVEN LOUIE DDS

Provider Business Mailing Address
First Line	:	3845 BEACON AVE STE C
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-1463
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7608 BRIDGEVIEW DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-4235
Country	:	US
Telephone Number	:	925-413-3614
Fax Number	:

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

Provider Enumeration Date	:	08/05/2020
Last Update Date	:	11/17/2020

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