Provider Demographics
NPI:1437258316
Name:LOFTUS, MICHAEL J (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:LOFTUS
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 1:10101 ACADEMY RD.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1120
Mailing Address - Country:US
Mailing Address - Phone:215-281-3400
Mailing Address - Fax:215-281-3477
Practice Address - Street 1:10101 ACADEMY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1120
Practice Address - Country:US
Practice Address - Phone:215-281-3400
Practice Address - Fax:215-281-3477
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-020530-L1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA023312OtherPERSONAL CHOICE
PA2220900OtherAETNA
PA0060844000OtherKEYSTONE
PA023312OtherBLUE SHIELD
PAT27112Medicare UPIN