Individual
KANE MICHAEL LOUSCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1250 E MARSHALL ST DEPT OF, RICHMOND, VA 23298-5023
(804) 828-0602
Mailing address
520 N 12TH ST # 238, RICHMOND, VA 23298-5064
(804) 628-6637
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0442000450
VA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0442000450
DENTAL RESIDENT'S LICENSE
VA
Enumeration date
04/13/2022
Last updated
08/01/2022
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