Provider Demographics
NPI:1659159515
Name:LOFTIN DENTAL LLC
Entity Type:Organization
Organization Name:LOFTIN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOFTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-485-3539
Mailing Address - Street 1:18030 CASCADES AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-5959
Mailing Address - Country:US
Mailing Address - Phone:225-485-3539
Mailing Address - Fax:
Practice Address - Street 1:6943 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8110
Practice Address - Country:US
Practice Address - Phone:225-923-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental