Healthcare Provider Details

I. General information

NPI: 1962422816
Provider Name (Legal Business Name): LOREN M LOEWEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S MAIN ST
HILLSBORO KS
67063-1527
US

IV. Provider business mailing address

615 S MAIN ST
HILLSBORO KS
67063-1527
US

V. Phone/Fax

Practice location:
  • Phone: 620-947-5771
  • Fax: 620-947-3253
Mailing address:
  • Phone: 620-947-5771
  • Fax: 620-947-3253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6482
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: