MEDICARE: JACQUELINE ELIZABETH LOESCH RDH

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	124Q00000X	Dental Hygienist	DH.002023951	CO

General Provider Information

NPI Number	:	1922406131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ELIZABETH LOESCH RDH

Provider Business Mailing Address
First Line	:	4041 E SAN MIGUEL ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3537
Country	:	US
Telephone Number	:	719-632-5700
Fax Number	:	719-344-7880

Provider Business Practice Location Address
First Line	:	4041 E SAN MIGUEL ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3537
Country	:	US
Telephone Number	:	719-632-5700
Fax Number	:	719-344-7880

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

Provider Enumeration Date	:	12/22/2014
Last Update Date	:	01/02/2024

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