Healthcare Provider Details

I. General information

NPI: 1962080481
Provider Name (Legal Business Name): MICHAEL B LOFTIS DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204B W ARLINGTON BLVD # B
GREENVILLE NC
27834-5762
US

IV. Provider business mailing address

PO BOX 13623
CHARLESTON WV
25360-0623
US

V. Phone/Fax

Practice location:
  • Phone: 252-689-2762
  • Fax: 252-689-2764
Mailing address:
  • Phone: 304-437-0655
  • Fax: 252-689-2764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: MS. G FRANCES LOFTIS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 304-437-0655