Provider Demographics
NPI:1194010744
Name:ABUKHALAF, LOUIS (DDS)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:
Last Name:ABUKHALAF
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 1:12620 MISTY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4423
Mailing Address - Country:US
Mailing Address - Phone:312-375-5306
Mailing Address - Fax:
Practice Address - Street 1:14560 RIVER RD STE 105
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-5802
Practice Address - Country:US
Practice Address - Phone:317-764-2938
Practice Address - Fax:317-219-6781
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120116601223E0200X, 1223G0001X, 1223S0112X, 122300000X
IN12011660A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery