Provider Demographics
NPI:1932257508
Name:SCHWARTZ, LOUIS O JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:O
Last Name:SCHWARTZ
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 NELSON BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4026
Mailing Address - Country:US
Mailing Address - Phone:843-355-7527
Mailing Address - Fax:843-355-9949
Practice Address - Street 1:515 NELSON BLVD
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4026
Practice Address - Country:US
Practice Address - Phone:843-355-7527
Practice Address - Fax:843-355-9949
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ15485Medicaid