Provider Demographics
NPI:1407920119
Name:LOUIE, RANDALL T (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:T
Last Name:LOUIE
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 1:2400 WESTBOROUGH BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5402
Mailing Address - Country:US
Mailing Address - Phone:650-583-8866
Mailing Address - Fax:
Practice Address - Street 1:2400 WESTBOROUGH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5402
Practice Address - Country:US
Practice Address - Phone:650-583-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice