Provider Demographics
NPI:1356364426
Name:LOOMIS, ALFONSO RAY (DMD)
Entity type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:RAY
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N SANTA ANITA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3112
Mailing Address - Country:US
Mailing Address - Phone:626-446-0106
Mailing Address - Fax:626-446-4934
Practice Address - Street 1:75 N SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3112
Practice Address - Country:US
Practice Address - Phone:626-446-0106
Practice Address - Fax:626-446-4934
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice