Provider Demographics
NPI:1598848780
Name:LOZA, JUAN CARLOS (DDS)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:LOZA
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 1:910 BROAD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3600
Mailing Address - Country:US
Mailing Address - Phone:571-218-9461
Mailing Address - Fax:
Practice Address - Street 1:737 WALKER RD
Practice Address - Street 2:SUITE 6
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-2833
Practice Address - Country:US
Practice Address - Phone:703-759-3011
Practice Address - Fax:703-759-6030
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014107361223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics