Provider Demographics
NPI:1164701033
Name:LOUIE, PHILLIP JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JAMES
Last Name:LOUIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BEISER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7795
Mailing Address - Country:US
Mailing Address - Phone:302-674-5437
Mailing Address - Fax:302-672-9091
Practice Address - Street 1:250 BEISER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7795
Practice Address - Country:US
Practice Address - Phone:302-674-5437
Practice Address - Fax:302-672-9091
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0387551223P0221X
DEG1-00013281223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist