Provider Demographics
NPI:1558667840
Name:DI LORETO, JAMES GUIDO (DMD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GUIDO
Last Name:DI LORETO
Suffix:
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 1:924 PEACH STREET
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1404
Mailing Address - Country:US
Mailing Address - Phone:814-455-5218
Mailing Address - Fax:
Practice Address - Street 1:924 PEACH STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1404
Practice Address - Country:US
Practice Address - Phone:814-455-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021497L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist