Provider Demographics
NPI:1750335758
Name:LOURIA, MICHAEL D (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:LOURIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5738 CANTON CV
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5037
Mailing Address - Country:US
Mailing Address - Phone:407-696-0053
Mailing Address - Fax:407-695-1674
Practice Address - Street 1:5738 CANTON CV
Practice Address - Street 2:SUITE 100
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5037
Practice Address - Country:US
Practice Address - Phone:407-696-0053
Practice Address - Fax:407-695-1674
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBL92119931223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics