Provider Demographics
NPI:1477929008
Name:LOUIS, AVRA MIRIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:AVRA
Middle Name:MIRIAM
Last Name:LOUIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AVRA
Other - Middle Name:MIRIAM
Other - Last Name:ASCULAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:85 WOODLAKE DR W
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2304
Mailing Address - Country:US
Mailing Address - Phone:516-574-3359
Mailing Address - Fax:
Practice Address - Street 1:85 WOODLAKE DR W
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2304
Practice Address - Country:US
Practice Address - Phone:516-574-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0455351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice