Provider Demographics
NPI:1003104043
Name:LOULY DENTISTRY, INC
Entity Type:Organization
Organization Name:LOULY DENTISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOULY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-869-0000
Mailing Address - Street 1:11530 E WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2828
Mailing Address - Country:US
Mailing Address - Phone:317-869-0000
Mailing Address - Fax:317-869-0233
Practice Address - Street 1:11530 E WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2828
Practice Address - Country:US
Practice Address - Phone:317-869-0000
Practice Address - Fax:317-869-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X, 1223P0700X, 332B00000X
IN12009247A1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty