Provider Demographics
NPI:1922406131
Name:LOESCH, JACQUELINE ELIZABETH (RDH)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELIZABETH
Last Name:LOESCH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ELIZABETH
Other - Last Name:PIRTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4041 E SAN MIGUEL ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3537
Mailing Address - Country:US
Mailing Address - Phone:719-632-5700
Mailing Address - Fax:719-344-7880
Practice Address - Street 1:4041 E SAN MIGUEL ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3537
Practice Address - Country:US
Practice Address - Phone:719-632-5700
Practice Address - Fax:719-344-7880
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002023951124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist