# LOULY DENTISTRY, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003104043
- **Authorized official:** DR. AMMAR C. LOULY DDS (PRESIDENT)
- **Authorized official phone:** (317) 869-0000

## Contact information

- **Practice address:** 11530 E WASHINGTON STREET, INDIANAPOLIS, IN 46229-2828
- **Practice address phone:** (317) 869-0000
- **Practice address fax:** (317) 869-0233
- **Mailing address:** 11530 E WASHINGTON STREET, INDIANAPOLIS, IN 46229-2828
- **Mailing address phone:** (317) 869-0000
- **Mailing address fax:** (317) 869-0233

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |
| 1223P0700X | Prosthodontics | 12009247A | IN | — |
| 1223P0700X | Prosthodontics | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | — | — |

## Other

- **Enumeration date:** 07/12/2011
- **Last updated:** 05/25/2023