Provider Demographics
NPI:1629754056
Name:CARLOS, LOUISE SALALILA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:SALALILA
Last Name:CARLOS
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 1:254 MAGICAL WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5519
Mailing Address - Country:US
Mailing Address - Phone:407-973-1147
Mailing Address - Fax:
Practice Address - Street 1:17300 STATE ROAD 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8140
Practice Address - Country:US
Practice Address - Phone:352-403-1298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN28236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist