Provider Demographics
NPI:1659055515
Name:LOEBLEIN, OLIVIA (DMD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:LOEBLEIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 OLSON RD
Mailing Address - Street 2:
Mailing Address - City:STONEBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16153-3621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:764 BESSEMER ST STE 100
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-1862
Practice Address - Country:US
Practice Address - Phone:814-336-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0441181223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice