Provider Demographics
NPI:1437205739
Name:LOOMIS, ROBERT R JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:LOOMIS
Suffix:JR
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 1:129 CANYONCREST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0143
Mailing Address - Country:US
Mailing Address - Phone:949-413-7407
Mailing Address - Fax:
Practice Address - Street 1:2000 HARBOR BLVD STE B100
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2601
Practice Address - Country:US
Practice Address - Phone:949-645-5070
Practice Address - Fax:949-645-4325
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice