Healthcare Provider Details

I. General information

NPI: 1871795849
Provider Name (Legal Business Name): JOHN PAUL LOFFREDO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 OAKRIDGE CMNS
SOUTH SALEM NY
10590-2437
US

IV. Provider business mailing address

203 OAKRIDGE CMNS
SOUTH SALEM NY
10590-2437
US

V. Phone/Fax

Practice location:
  • Phone: 914-533-5200
  • Fax:
Mailing address:
  • Phone: 914-533-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number043355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: