Provider Demographics
NPI:1679035786
Name:O'LOUGHLIN, THOMAS
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:O'LOUGHLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 OMAR BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-9401
Mailing Address - Country:US
Mailing Address - Phone:660-269-7722
Mailing Address - Fax:660-269-7723
Practice Address - Street 1:1750 OMAR BRADLEY RD
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9401
Practice Address - Country:US
Practice Address - Phone:660-269-7722
Practice Address - Fax:660-269-7723
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV72631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice