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General NPI Number Information
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NPI Number | 1801194543
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Entity Type | Organization
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Legal Business Name | LOUIS S. DELORIE, D.D.S., P.S.
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 4362 - 15TH AVENUE SOUTH
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City | SEATTLE
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State | WA
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Zip | 98108-1446
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Country | US
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Telephone | 206-762-4060
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Fax | 206-988-1298
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Provider Business Mailing Address
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Address Line | 4362 - 15TH AVENUE SOUTH
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City | SEATTLE
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State | WA
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Zip | 98108-1446
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Country | US
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Telephone | 206-762-4060
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Fax | 206-988-1298
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LOUIS STEPHEN DELORIE
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Credential | D.D.S.
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Telephone | 206-762-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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