Provider Demographics
NPI:1821486739
Name:DR LISA ANN LOESCHER & ASSOCIATES FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:DR LISA ANN LOESCHER & ASSOCIATES FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOESCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-643-6620
Mailing Address - Street 1:1400 OLD SPANISH TRL STE A
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5022
Mailing Address - Country:US
Mailing Address - Phone:985-643-2040
Mailing Address - Fax:985-641-8707
Practice Address - Street 1:1400 OLD SPANISH TRL STE A
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5022
Practice Address - Country:US
Practice Address - Phone:985-643-2040
Practice Address - Fax:985-641-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA47951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty