Provider Demographics
NPI:1699808899
Name:LOULY, AMMAR C (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMMAR
Middle Name:C
Last Name:LOULY
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 1:11530 E WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2828
Mailing Address - Country:US
Mailing Address - Phone:317-869-0000
Mailing Address - Fax:317-869-0233
Practice Address - Street 1:11530 E WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2828
Practice Address - Country:US
Practice Address - Phone:317-869-0000
Practice Address - Fax:317-869-0233
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120092471223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN31-1915397OtherTAX ID. #