Provider Demographics
NPI:1952819211
Name:RJ LOERA DDS PLLC
Entity Type:Organization
Organization Name:RJ LOERA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:LOERA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-270-2911
Mailing Address - Street 1:3133 N TOWN EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3920
Mailing Address - Country:US
Mailing Address - Phone:972-270-2911
Mailing Address - Fax:972-270-0798
Practice Address - Street 1:3133 N TOWN EAST BLVD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-270-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1962816355OtherPERSONAL NPI