Provider Demographics
NPI:1619196664
Name:MANDY J. LOUIS, D.M.D., P.L.L.C.
Entity Type:Organization
Organization Name:MANDY J. LOUIS, D.M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-277-0670
Mailing Address - Street 1:17600 TALBOT RD S
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5788
Mailing Address - Country:US
Mailing Address - Phone:425-277-0670
Mailing Address - Fax:425-228-1644
Practice Address - Street 1:17600 TALBOT RD S
Practice Address - Street 2:SUITE 5
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5788
Practice Address - Country:US
Practice Address - Phone:425-277-0670
Practice Address - Fax:425-228-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty