Provider Demographics
NPI:1609095744
Name:LOUIS, MANDY J (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:J
Last Name:LOUIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16655 108TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5108
Mailing Address - Country:US
Mailing Address - Phone:425-277-0670
Mailing Address - Fax:425-228-1644
Practice Address - Street 1:16655 108TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5108
Practice Address - Country:US
Practice Address - Phone:425-277-0670
Practice Address - Fax:425-228-1644
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000106421223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics