Provider Demographics
NPI:1992134324
Name:JAMES C.LOOTS JR. DDS PA
Entity type:Organization
Organization Name:JAMES C.LOOTS JR. DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLARENCE
Authorized Official - Last Name:LOOTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-781-3321
Mailing Address - Street 1:535 40TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3836
Mailing Address - Country:US
Mailing Address - Phone:763-781-3321
Mailing Address - Fax:763-781-5744
Practice Address - Street 1:535 40TH AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HTS
Practice Address - State:MN
Practice Address - Zip Code:55421-3836
Practice Address - Country:US
Practice Address - Phone:763-781-3321
Practice Address - Fax:763-781-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty