Provider Demographics
NPI:1992824965
Name:LOUCKS, CARNEY DANIEL (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:CARNEY
Middle Name:DANIEL
Last Name:LOUCKS
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E 17TH ST S
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-4057
Mailing Address - Country:US
Mailing Address - Phone:641-792-7811
Mailing Address - Fax:641-791-7090
Practice Address - Street 1:411 E 17TH ST S
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-4057
Practice Address - Country:US
Practice Address - Phone:641-792-7811
Practice Address - Fax:641-791-7090
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA66841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0202689Medicaid