Provider Demographics
NPI:1558413468
Name:LOEFFLER, KENNETH D II (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:D
Last Name:LOEFFLER
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 OREGON PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4604
Mailing Address - Country:US
Mailing Address - Phone:717-596-6484
Mailing Address - Fax:888-855-9867
Practice Address - Street 1:2131 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4604
Practice Address - Country:US
Practice Address - Phone:717-596-6484
Practice Address - Fax:888-855-9867
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1043268774OtherPRACTICE NPI
18790OtherDELTA
12902OtherBCBS
T76674Medicare UPIN
12902OtherBCBS