Provider Demographics
NPI:1881042802
Name:LOEB, MITCHELL ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ANDREW
Last Name:LOEB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 TWIN RIVERS CT
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2015
Mailing Address - Country:US
Mailing Address - Phone:913-620-2958
Mailing Address - Fax:
Practice Address - Street 1:140 TWIN RIVERS CT
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2015
Practice Address - Country:US
Practice Address - Phone:913-620-2958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016016887122300000X
MND13864122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist