Provider Demographics
NPI:1124148531
Name:LOUISA COMPREHENSIVE DENTAL
Entity type:Organization
Organization Name:LOUISA COMPREHENSIVE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KURT
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-967-5800
Mailing Address - Street 1:411 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093-6518
Mailing Address - Country:US
Mailing Address - Phone:540-967-5800
Mailing Address - Fax:540-967-5858
Practice Address - Street 1:411 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:VA
Practice Address - Zip Code:23093-6518
Practice Address - Country:US
Practice Address - Phone:540-967-5800
Practice Address - Fax:540-967-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014114671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty