Provider Demographics
NPI:1255444675
Name:LOESER, SCOTT F (DMD PC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:F
Last Name:LOESER
Suffix:
Gender:M
Credentials:DMD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:THORNWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10594
Mailing Address - Country:US
Mailing Address - Phone:914-769-0799
Mailing Address - Fax:914-769-5011
Practice Address - Street 1:974 BROADWAY
Practice Address - Street 2:
Practice Address - City:THORNWOOD
Practice Address - State:NY
Practice Address - Zip Code:10594
Practice Address - Country:US
Practice Address - Phone:914-769-0799
Practice Address - Fax:914-769-5011
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04910011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice