Healthcare Provider Details

I. General information

NPI: 1992824965
Provider Name (Legal Business Name): CARNEY DANIEL LOUCKS D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E 17TH ST S
NEWTON IA
50208-4057
US

IV. Provider business mailing address

411 E 17TH ST S
NEWTON IA
50208-4057
US

V. Phone/Fax

Practice location:
  • Phone: 641-792-7811
  • Fax: 641-791-7090
Mailing address:
  • Phone: 641-792-7811
  • Fax: 641-791-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6684
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: