Provider Demographics
NPI:1356512594
Name:LOOBY, TERRENCE PATRICK (DDS)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:PATRICK
Last Name:LOOBY
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 1:7310 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3531
Mailing Address - Country:US
Mailing Address - Phone:773-622-6139
Mailing Address - Fax:773-622-6199
Practice Address - Street 1:7310 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3531
Practice Address - Country:US
Practice Address - Phone:773-622-6139
Practice Address - Fax:773-622-6199
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice