Organization
G SCOTT LOUDERBACK DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY S LOUDERBACK DDS (OWNER)
(419) 693-1234
Entity
Organization
Contact information
Practice address
631 S WHEELING ST, OREGON, OH 43616-2742
(419) 693-1234
Mailing address
631 S WHEELING ST, OREGON, OH 43616-2742
(419) 693-1234
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316100167
INDIVIDUAL NPI NUMBER
OH
Enumeration date
03/12/2012
Last updated
03/12/2012
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