Healthcare Provider Details

I. General information

NPI: 1144377516
Provider Name (Legal Business Name): JAMES ANTHONY LOYOLA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 CANAL ST STE. 401
NEW ORLEANS LA
70119-5840
US

IV. Provider business mailing address

4902 CANAL ST STE. 401
NEW ORLEANS LA
70119-5840
US

V. Phone/Fax

Practice location:
  • Phone: 504-484-7246
  • Fax: 504-488-0061
Mailing address:
  • Phone: 504-484-7246
  • Fax: 504-488-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4143
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: