Healthcare Provider Details

I. General information

NPI: 1841796794
Provider Name (Legal Business Name): ASHLEY LOFTERS-DEANE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

12839 DAYLIGHT DR APT 2314
SAINT LOUIS MO
63131-1947
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6725
  • Fax:
Mailing address:
  • Phone: 203-449-6968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02946800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2026010387
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number063161-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: