Provider Demographics
NPI:1700962859
Name:LOFTON, RODNEY GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:GLENN
Last Name:LOFTON
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 1:16976 MANCHESTER RD
Mailing Address - Street 2:PO BOX 390
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1200
Mailing Address - Country:US
Mailing Address - Phone:636-458-9090
Mailing Address - Fax:636-458-9536
Practice Address - Street 1:16976 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:GROVER
Practice Address - State:MO
Practice Address - Zip Code:63040-1200
Practice Address - Country:US
Practice Address - Phone:636-458-9090
Practice Address - Fax:636-458-9536
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0156211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice