Healthcare Provider Details

I. General information

NPI: 1922090695
Provider Name (Legal Business Name): JOSHUA C. LOONEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19600 E ROSS ST
TAHLEQUAH OK
74464-0545
US

IV. Provider business mailing address

317 CRESTWOOD DR
TAHLEQUAH OK
74464-8035
US

V. Phone/Fax

Practice location:
  • Phone: 539-234-1000
  • Fax: 918-453-1339
Mailing address:
  • Phone: 918-458-1815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5772
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: