Healthcare Provider Details

I. General information

NPI: 1538866108
Provider Name (Legal Business Name): LOUIE PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BEISER BLVD STE 101
DOVER DE
19904-7795
US

IV. Provider business mailing address

250 BEISER BLVD STE 101
DOVER DE
19904-7795
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 TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILLIP JAMES LOUIE
Title or Position: OWNER
Credential: DMD
Phone: 302-674-5437