Provider Demographics
NPI:1346473402
Name:LOUK, JEREMY (DMD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:LOUK
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 1:1 CHISHOLM TRAIL RD STE 3130
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5002
Mailing Address - Country:US
Mailing Address - Phone:512-255-9061
Mailing Address - Fax:512-255-1422
Practice Address - Street 1:1 CHISHOLM TRAIL RD STE 3130
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5002
Practice Address - Country:US
Practice Address - Phone:512-255-9061
Practice Address - Fax:512-255-1422
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297071223G0001X
IDD4248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist