Provider Demographics
NPI:1134517139
Name:EMINE C. LOXLEY DMD, PC
Entity Type:Organization
Organization Name:EMINE C. LOXLEY DMD, PC
Other - Org Name:SANTA ROSA ENDODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOXLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:707-545-4104
Mailing Address - Street 1:3536 MENDOCINO AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-545-4104
Mailing Address - Fax:707-545-9668
Practice Address - Street 1:3536 MENDOCINO AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3634
Practice Address - Country:US
Practice Address - Phone:707-545-4104
Practice Address - Fax:707-545-9668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57813261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental