Provider Demographics
NPI:1609961531
Name:LOE, CAROL J (DDS, PS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:J
Last Name:LOE
Suffix:
Gender:F
Credentials:DDS, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 OLIVE WAY
Mailing Address - Street 2:SUITE 822
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1878
Mailing Address - Country:US
Mailing Address - Phone:206-467-8300
Mailing Address - Fax:206-467-7724
Practice Address - Street 1:720 OLIVE WAY
Practice Address - Street 2:SUITE 822
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1878
Practice Address - Country:US
Practice Address - Phone:206-467-8300
Practice Address - Fax:206-467-7724
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000059041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice