Provider Demographics
NPI:1316110380
Name:TERRENCE P. LOOBY, D.D.S.
Entity type:Organization
Organization Name:TERRENCE P. LOOBY, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LOOBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-844-5666
Mailing Address - Street 1:1800 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-3732
Mailing Address - Country:US
Mailing Address - Phone:708-345-5505
Mailing Address - Fax:705-345-8338
Practice Address - Street 1:1800 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3732
Practice Address - Country:US
Practice Address - Phone:708-345-5505
Practice Address - Fax:705-345-8338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty