Provider Demographics
NPI:1306184528
Name:LOFTIN DENTAL, PLLC
Entity type:Organization
Organization Name:LOFTIN DENTAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MISHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-664-8352
Mailing Address - Street 1:110 N ALMOND ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4814
Mailing Address - Country:US
Mailing Address - Phone:361-664-8352
Mailing Address - Fax:361-664-9305
Practice Address - Street 1:110 N ALMOND ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4814
Practice Address - Country:US
Practice Address - Phone:361-664-8352
Practice Address - Fax:361-664-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2025-01-13
Deactivation Date:2022-06-02
Deactivation Code:
Reactivation Date:2022-09-09
Provider Licenses
StateLicense IDTaxonomies
TX141381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty