Healthcare Provider Details

I. General information

NPI: 1427802388
Provider Name (Legal Business Name): JUAN PABLO LOJA ROLDAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAIN ST FL 2
MILFORD MA
01757-2634
US

IV. Provider business mailing address

21 MAIN ST FL 2
MILFORD MA
01757-2634
US

V. Phone/Fax

Practice location:
  • Phone: 508-478-1555
  • Fax: 508-478-7105
Mailing address:
  • Phone: 508-478-1555
  • Fax: 508-478-7105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001481
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: