Provider Demographics
NPI:1437227683
Name:LOUGHLIN, NICOLE CATHARINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:CATHARINE
Last Name:LOUGHLIN
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 1:74 OUTLOOK POINT
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006
Mailing Address - Country:US
Mailing Address - Phone:830-336-2001
Mailing Address - Fax:
Practice Address - Street 1:415 S SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2519
Practice Address - Country:US
Practice Address - Phone:830-249-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1483368OtherUNITED CONCORDIA
TX180426202Medicaid