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General NPI Number Information
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NPI Number | 1629715560
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Entity Type | Individual
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Provider Name | KEVIN LOU DMD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2022
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 283 BROAD ST
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City | NASHUA
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State | NH
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Zip | 03063-3160
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Country | US
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Telephone | 603-882-7312
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Fax |
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Provider Business Mailing Address
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Address Line | 107 S RIVER RD APT 414
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City | BEDFORD
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State | NH
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Zip | 03110-6785
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Country | US
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Telephone | 770-864-6098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 04743
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1859374
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License Number State | MA
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