Healthcare Provider Details

I. General information

NPI: 1306150883
Provider Name (Legal Business Name): JOHN WALKER LOEFFELHOLZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD ROOM D1-17
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1230 SW 11TH AVE #114
GAINESVILLE FL
32601-8251
US

V. Phone/Fax

Practice location:
  • Phone: 817-343-4692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number25792
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: