Provider Demographics
NPI:1275783219
Name:DALE, LOUIS L (DDS)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:L
Last Name:DALE
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 1:14538 LOLLY LN STE D
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8447
Mailing Address - Country:US
Mailing Address - Phone:209-532-4999
Mailing Address - Fax:
Practice Address - Street 1:14538 LOLLY LN STE D
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-8447
Practice Address - Country:US
Practice Address - Phone:209-532-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA348311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice