Provider Demographics
NPI:1902859135
Name:BELK, LOUQUIS CANTY
Entity Type:Individual
Prefix:
First Name:LOUQUIS
Middle Name:CANTY
Last Name:BELK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOUQUIS
Other - Middle Name:PATRELL CANTY
Other - Last Name:BELK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3788
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29230-3788
Mailing Address - Country:US
Mailing Address - Phone:803-733-5969
Mailing Address - Fax:803-217-0026
Practice Address - Street 1:755 US HIGHWAY 21 S
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:SC
Practice Address - Zip Code:29130-6844
Practice Address - Country:US
Practice Address - Phone:803-337-2920
Practice Address - Fax:803-337-3010
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ34142Medicaid