Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DL12637 | MA |
Y | 1223E0200X | Endodontist | 04673 | NH |
N | 1223E0200X | Endodontist | DEN4841 | ME |
NPI | 1033593751 |
---|---|
Provider Name | Dr. Louis Deluke |
First Address | Portsmouth, NH 03801 |
Second Address | Boston, MA 02118-1831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2015 |
Last Update Date | 24/09/2021 |