Provider Demographics
NPI:1508082819
Name:LOOMER, PETER MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:LOOMER
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 1:521 PARNASSUS AVE. C628
Mailing Address - Street 2:BOX 0650
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94903-5004
Mailing Address - Country:US
Mailing Address - Phone:415-502-7896
Mailing Address - Fax:415-502-4990
Practice Address - Street 1:707 PARNASSUS AVENUE
Practice Address - Street 2:BOX 0762
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94903-0762
Practice Address - Country:US
Practice Address - Phone:415-476-1731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP1981223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics