Provider Demographics
NPI:1346311396
Name:LOUICK, JONATHAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:LOUICK
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 1:8 POND'S EDGE DRIVE
Mailing Address - Street 2:SUITE#2
Mailing Address - City:CHADDSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317
Mailing Address - Country:US
Mailing Address - Phone:610-388-4466
Mailing Address - Fax:610-388-5808
Practice Address - Street 1:8 POND'S EDGE DRIVE
Practice Address - Street 2:SUITE#2
Practice Address - City:CHADDSFORD
Practice Address - State:PA
Practice Address - Zip Code:19317
Practice Address - Country:US
Practice Address - Phone:610-388-4466
Practice Address - Fax:610-388-5808
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0356921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101397399Medicaid
PA101397399Medicare ID - Type Unspecified