Provider Demographics
NPI:1609096833
Name:LOFTHOUSE, RICHARD MERWIN SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MERWIN
Last Name:LOFTHOUSE
Suffix:SR
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 1:220 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FENNIMORE
Mailing Address - State:WI
Mailing Address - Zip Code:53809
Mailing Address - Country:US
Mailing Address - Phone:608-822-3770
Mailing Address - Fax:
Practice Address - Street 1:220 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FENNIMORE
Practice Address - State:WI
Practice Address - Zip Code:53809
Practice Address - Country:US
Practice Address - Phone:608-822-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2811-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice