Provider Demographics
NPI:1700058401
Name:TERRENCE P. LOOBY,D.D.S.
Entity Type:Organization
Organization Name:TERRENCE P. LOOBY,D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LOOBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-844-5666
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty