Provider Demographics
NPI:1952837155
Name:DENTAL GROUP OF EMINE LOXLEY, DDS, INC
Entity type:Organization
Organization Name:DENTAL GROUP OF EMINE LOXLEY, DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOXLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-419-1211
Mailing Address - Street 1:1144 SONOMA AVE
Mailing Address - Street 2:#107
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4812
Mailing Address - Country:US
Mailing Address - Phone:707-579-5533
Mailing Address - Fax:
Practice Address - Street 1:1144 SONOMA AVE
Practice Address - Street 2:#107
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4812
Practice Address - Country:US
Practice Address - Phone:707-579-5533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57813261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental