Provider Demographics
NPI:1710499660
Name:CHRISTOPHER B. LOOMIS DMD PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER B. LOOMIS DMD PLLC
Other - Org Name:HELENA DENTAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:LOOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-819-6965
Mailing Address - Street 1:907 HELENA AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3425
Mailing Address - Country:US
Mailing Address - Phone:406-442-4990
Mailing Address - Fax:406-442-4939
Practice Address - Street 1:907 HELENA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3425
Practice Address - Country:US
Practice Address - Phone:406-442-4990
Practice Address - Fax:406-442-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT97051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty