Provider Demographics
NPI:1871646158
Name:DR. FRED A. LOE D.D.S., P.A.
Entity Type:Organization
Organization Name:DR. FRED A. LOE D.D.S., P.A.
Other - Org Name:NORTH TARRANT OMFS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:LOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-237-7557
Mailing Address - Street 1:820 TOWNE CT
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1279
Mailing Address - Country:US
Mailing Address - Phone:817-237-7557
Mailing Address - Fax:817-237-7585
Practice Address - Street 1:820 TOWNE CT
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1279
Practice Address - Country:US
Practice Address - Phone:817-237-7557
Practice Address - Fax:817-223-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty