Provider Demographics
NPI:1902007685
Name:LOFTUS, JEFFREY THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:LOFTUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JEFF
Other - Middle Name:T
Other - Last Name:LOFTUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5615 NUGGET GULCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702
Mailing Address - Country:US
Mailing Address - Phone:605-341-4521
Mailing Address - Fax:605-341-9750
Practice Address - Street 1:5615 NUGGET GULCH DRIVE
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702
Practice Address - Country:US
Practice Address - Phone:605-341-4521
Practice Address - Fax:605-341-9750
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice