Provider Demographics
NPI:1942404397
Name:LOIACONO, CARLA CARMEN (RDHAP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:CARMEN
Last Name:LOIACONO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 WINFIELD BLVD SPC 153
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2422
Mailing Address - Country:US
Mailing Address - Phone:408-608-7292
Mailing Address - Fax:
Practice Address - Street 1:5770 WINFIELD BLVD SPC 153
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2422
Practice Address - Country:US
Practice Address - Phone:408-608-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP183124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist