Provider Demographics
NPI:1336354497
Name:LOOSVELT, ROBERT MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:LOOSVELT
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 1:4555 INVESTMENT DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6338
Mailing Address - Country:US
Mailing Address - Phone:248-641-0055
Mailing Address - Fax:248-641-1922
Practice Address - Street 1:4555 INVESTMENT DR
Practice Address - Street 2:SUITE 305
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6338
Practice Address - Country:US
Practice Address - Phone:248-641-0055
Practice Address - Fax:248-641-1922
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901009900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist