Healthcare Provider Details

I. General information

NPI: 1346248895
Provider Name (Legal Business Name): LAWRENCE A LOUIE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BEISER BLVD SUITE 101
DOVER DE
19904-7790
US

IV. Provider business mailing address

250 BEISER BLVD SUITE 101
DOVER DE
19904-7790
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-5437
  • Fax: 302-672-9091
Mailing address:
  • Phone: 302-674-5437
  • Fax: 302-672-9091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberG1-0000993
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: