Provider Demographics
NPI:1093372245
Name:KONSTAN, LOUIS JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:JEFFREY
Last Name:KONSTAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-1514
Mailing Address - Country:US
Mailing Address - Phone:330-628-3017
Mailing Address - Fax:
Practice Address - Street 1:11 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-1514
Practice Address - Country:US
Practice Address - Phone:330-628-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025796122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist