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General NPI Number Information
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NPI Number | 1912053661
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Entity Type | Individual
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Provider Name | LOUIS M GORMAN D.D.S
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 1330 LIBERTY RD STE C
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City | ELDERSBURG
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State | MD
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Zip | 21784-5319
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Country | US
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Telephone | 443-776-1836
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Fax |
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Provider Business Mailing Address
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Address Line | 10938 BASKERVILLE RD
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City | REISTERSTOWN
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State | MD
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Zip | 21136-6422
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Country | US
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Telephone | 443-286-7428
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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 | 10997
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License Number State | MD
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