Provider Demographics
NPI:1386429678
Name:LOONEY, THEODORE EMANUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:EMANUEL
Last Name:LOONEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 NW 204TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2359
Mailing Address - Country:US
Mailing Address - Phone:206-280-2867
Mailing Address - Fax:
Practice Address - Street 1:10383 TORRE AVE STE I
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3297
Practice Address - Country:US
Practice Address - Phone:408-527-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist