Provider Demographics
NPI:1518975713
Name:LOUSCHER, MICHAEL WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:LOUSCHER
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:LUSH DENTAL, PLC
Mailing Address - Street 2:2505 SE ENCOMPASS DR.
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8099
Mailing Address - Country:US
Mailing Address - Phone:515-303-0909
Mailing Address - Fax:641-421-7622
Practice Address - Street 1:LUSH DENTAL, PLC
Practice Address - Street 2:2505 SE ENCOMPASS DR.
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8099
Practice Address - Country:US
Practice Address - Phone:515-303-0909
Practice Address - Fax:641-421-7622
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7831122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0140079Medicaid