Healthcare Provider Details

I. General information

NPI: 1912200080
Provider Name (Legal Business Name): LOUBNA PLA DDS MSD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5615 78TH AVENUE CT W
UNIVERSITY PLACE WA
98467-3981
US

IV. Provider business mailing address

5615 78TH AVENUE CT W
UNIVERSITY PLACE WA
98467-3981
US

V. Phone/Fax

Practice location:
  • Phone: 253-906-9866
  • Fax:
Mailing address:
  • Phone: 253-906-9866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. LOUBNA CHEHAB PLA
Title or Position: DR
Credential: DDS, MSD
Phone: 253-906-9866