Provider Demographics
NPI:1912053661
Name:GORMAN, LOUIS M (DDS)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:M
Last Name:GORMAN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10938 BASKERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6422
Mailing Address - Country:US
Mailing Address - Phone:443-286-7428
Mailing Address - Fax:
Practice Address - Street 1:1330 LIBERTY RD STE C
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-5319
Practice Address - Country:US
Practice Address - Phone:443-776-1836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD109971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521-598-930OtherTIN