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General NPI Number Information
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NPI Number | 1104245398
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Entity Type | Organization
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Legal Business Name | BRADLEY C. LOUIE, DDS, INC.
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 4255 PACIFIC AVE STE 1
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City | STOCKTON
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State | CA
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Zip | 95207-7638
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Country | US
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Telephone | 209-478-5616
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Fax | 209-478-0556
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Provider Business Mailing Address
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Address Line | 4255 PACIFIC AVE STE 1
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City | STOCKTON
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State | CA
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Zip | 95207-7638
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Country | US
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Telephone | 209-478-5616
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Fax | 209-478-0556
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. BRADLEY CARLSON LOUIE
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Credential | DDS
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Telephone | 209-478-5616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 32739
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License Number State | CA
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