Provider Demographics
NPI:1023215977
Name:LOESBERG, KENNETH T (DMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:T
Last Name:LOESBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 NUTT ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460
Mailing Address - Country:US
Mailing Address - Phone:610-933-3881
Mailing Address - Fax:610-933-9383
Practice Address - Street 1:145 NUTT ROAD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:610-933-3881
Practice Address - Fax:610-933-9383
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017937122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist