Provider Demographics
NPI:1285678003
Name:LOFGREN, JAMES W (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:LOFGREN
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 1:5042 CR 8940
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2075
Mailing Address - Country:US
Mailing Address - Phone:417-255-9800
Mailing Address - Fax:417-257-2911
Practice Address - Street 1:310 KENTUCKY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65755-2075
Practice Address - Country:US
Practice Address - Phone:417-255-9800
Practice Address - Fax:417-257-2911
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015763122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO730469OtherUNITED CONCORDIA
MO176064OtherBCBS