Provider Demographics
NPI:1073780284
Name:LOFTIS, MICHAEL BLAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BLAINE
Last Name:LOFTIS
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:PO BOX 13623
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25360-0623
Mailing Address - Country:US
Mailing Address - Phone:304-437-0655
Mailing Address - Fax:252-689-2764
Practice Address - Street 1:204B W ARLINGTON BLVD # B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5762
Practice Address - Country:US
Practice Address - Phone:252-689-2762
Practice Address - Fax:252-689-2764
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV36511223E0200X
NC117101223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics