Provider Demographics
NPI:1326249525
Name:LOESCHER, LISA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:LOESCHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 OLD SPANISH TRL STE B
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5022
Mailing Address - Country:US
Mailing Address - Phone:985-643-6620
Mailing Address - Fax:
Practice Address - Street 1:1400 OLD SPANISH TRL STE B
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5022
Practice Address - Country:US
Practice Address - Phone:985-643-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4795122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist