Provider Demographics
NPI:1356496418
Name:LOSACCO, THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:LOSACCO
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:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80444-1022
Mailing Address - Country:US
Mailing Address - Phone:303-569-3141
Mailing Address - Fax:303-569-3041
Practice Address - Street 1:801 6TH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:CO
Practice Address - Zip Code:80444-1022
Practice Address - Country:US
Practice Address - Phone:303-569-3141
Practice Address - Fax:303-569-3041
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1055841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02055846Medicaid