Provider Demographics
NPI:1093909038
Name:LOU, LEO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:LOU
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 1:8510 111 ST. APT#1003
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T6G 1H7
Mailing Address - Country:CA
Mailing Address - Phone:780-988-2345
Mailing Address - Fax:
Practice Address - Street 1:8510 111 ST. APT#1003
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:ALBERTA
Practice Address - Zip Code:T6G 1H7
Practice Address - Country:CA
Practice Address - Phone:780-988-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics