Provider Demographics
NPI:1831676121
Name:LOI, MINERVA (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:MINERVA
Middle Name:
Last Name:LOI
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3205
Mailing Address - Country:US
Mailing Address - Phone:650-307-7093
Mailing Address - Fax:
Practice Address - Street 1:1525 30TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-3205
Practice Address - Country:US
Practice Address - Phone:650-307-7093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102035122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist