Healthcare Provider Details

I. General information

NPI: 1609662899
Provider Name (Legal Business Name): LUC LOYOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SW HUNTOON ST
TOPEKA KS
66604-1231
US

IV. Provider business mailing address

13108 TIFTON DR
TAMPA FL
33618-3020
US

V. Phone/Fax

Practice location:
  • Phone: 785-861-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62453
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number14383
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: