Provider Demographics
NPI:1396802518
Name:LOOMER, LAUREL EVELYN (RDHAP)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:EVELYN
Last Name:LOOMER
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95031-0899
Mailing Address - Country:US
Mailing Address - Phone:408-358-0209
Mailing Address - Fax:408-358-0209
Practice Address - Street 1:16470 W LA CHIQUITA AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4635
Practice Address - Country:US
Practice Address - Phone:408-358-0209
Practice Address - Fax:408-358-0209
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA161124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist