Provider Demographics
NPI:1225255946
Name:DAVID O. LOFTUS D.D.S., INC.
Entity Type:Organization
Organization Name:DAVID O. LOFTUS D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:O
Authorized Official - Last Name:LOFTUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-262-7427
Mailing Address - Street 1:865 E 4800 S
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5043
Mailing Address - Country:US
Mailing Address - Phone:801-262-7427
Mailing Address - Fax:
Practice Address - Street 1:865 E 4800 S
Practice Address - Street 2:SUITE 250
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5043
Practice Address - Country:US
Practice Address - Phone:801-262-7427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT141902-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT519689040018Medicaid