Healthcare Provider Details

I. General information

NPI: 1922155969
Provider Name (Legal Business Name): ROBERT M. LOFTIN, D.D.S., M.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OAKCREST AVE SUITE D
GREENSBORO NC
27408-4722
US

IV. Provider business mailing address

2601 OAKCREST AVE SUITE D
GREENSBORO NC
27408-4722
US

V. Phone/Fax

Practice location:
  • Phone: 336-288-1966
  • Fax:
Mailing address:
  • Phone: 336-288-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6152
License Number StateNC

VIII. Authorized Official

Name: DR. ROBERT LOFTIN
Title or Position: PRESIDENT AND OWNER
Credential: D.D.S.
Phone: 336-288-1966