Healthcare Provider Details

I. General information

NPI: 1376469858
Provider Name (Legal Business Name): SAM LOFQUIST DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30900 RANCHO VIEJO RD STE 265
SAN JUAN CAPISTRANO CA
92675-1762
US

IV. Provider business mailing address

8 VISTAMAR DR
LAGUNA NIGUEL CA
92677-5632
US

V. Phone/Fax

Practice location:
  • Phone: 949-545-9951
  • Fax:
Mailing address:
  • Phone: 651-402-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: