Provider Demographics
NPI:1265584007
Name:LOZA, LUIS (DDS)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:LOZA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 S KING ST STE 302
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3919
Mailing Address - Country:US
Mailing Address - Phone:703-777-2442
Mailing Address - Fax:703-777-1510
Practice Address - Street 1:602 S KING ST
Practice Address - Street 2:SUITE 302
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3919
Practice Address - Country:US
Practice Address - Phone:703-777-2442
Practice Address - Fax:703-777-1510
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA113660124OtherTAX IDENTIFICATION
VA542034392OtherTAX IDENTIFICATION
VA841629676OtherTAX IDENTIFICATION