Healthcare Provider Details

I. General information

NPI: 1194010744
Provider Name (Legal Business Name): LOUIS ABUKHALAF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2011
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14560 RIVER RD STE 105
CARMEL IN
46033-5802
US

IV. Provider business mailing address

12620 MISTY RIDGE CT
FISHERS IN
46037-4423
US

V. Phone/Fax

Practice location:
  • Phone: 317-764-2938
  • Fax: 317-219-6781
Mailing address:
  • Phone: 312-375-5306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12011660
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12011660A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12011660
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12011660
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12011660
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: