Provider Demographics
NPI:1457969024
Name:LOUL, MAHMOOD (DDS)
Entity Type:Individual
Prefix:
First Name:MAHMOOD
Middle Name:
Last Name:LOUL
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 1:1805 E CABRILLO BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2884
Mailing Address - Country:US
Mailing Address - Phone:805-565-5111
Mailing Address - Fax:
Practice Address - Street 1:1805 E CABRILLO BLVD STE A
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-2884
Practice Address - Country:US
Practice Address - Phone:805-565-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist