Provider Demographics
NPI:1346279866
Name:KIHLSTROM, LOREN W (DDS)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:W
Last Name:KIHLSTROM
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 1:1262 CONCANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-6002
Mailing Address - Country:US
Mailing Address - Phone:925-447-9300
Mailing Address - Fax:925-447-9308
Practice Address - Street 1:1262 CONCANNON BLVD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6002
Practice Address - Country:US
Practice Address - Phone:925-447-9300
Practice Address - Fax:925-447-9308
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA203871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice