Provider Demographics
NPI:1932279932
Name:CHITTENANGO DENTAL
Entity Type:Organization
Organization Name:CHITTENANGO DENTAL
Other - Org Name:SHAMUS LOFTUS DDS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAMUS
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOFTUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-687-3386
Mailing Address - Street 1:153 WEST GENESEE STREET
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037
Mailing Address - Country:US
Mailing Address - Phone:315-687-3386
Mailing Address - Fax:315-687-3387
Practice Address - Street 1:153 WEST GENESEE STREET
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037
Practice Address - Country:US
Practice Address - Phone:315-687-3386
Practice Address - Fax:315-687-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty