MEDICARE: DR. T CARL LOEFFLER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	5396	NV

General Provider Information

NPI Number	:	1720170459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. T CARL LOEFFLER DDS

Provider Business Mailing Address
First Line	:	3555 S. TOWN CENTER DR.
Second Line	:	SUITE 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89135
Country	:	US
Telephone Number	:	702-541-7070
Fax Number	:	702-541-7071

Provider Business Practice Location Address
First Line	:	3555 S. TOWN CENTER DR.
Second Line	:	SUITE 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89135
Country	:	US
Telephone Number	:	702-541-7070
Fax Number	:	702-541-7071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	06/21/2010

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