Individual
JACK LOUIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
110 STUART ST UNIT 18A, BOSTON, MA 02116-5668
(901) 258-3188
Mailing address
110 STUART ST UNIT 18A, BOSTON, MA 02116-5668
(901) 258-3188
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
14351
CT
1223D0004X
Dental Anesthesiology
Primary
DN1859750
MA
1223P0221X
Pediatric Dentistry
DN1859750
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/06/2012
Last updated
05/10/2025
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