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General NPI Number Information
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NPI Number | 1669752515
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Entity Type | Organization
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Legal Business Name | FLOR D. LOYA DDS LTD
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 134 W VALLETTE ST
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City | ELMHURST
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State | IL
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Zip | 60126-4451
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Country | US
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Telephone | 708-344-5437
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Fax | 708-344-2757
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Provider Business Mailing Address
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Address Line | 154 N 19TH AVE SUITE 200
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City | MELROSE PARK
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State | IL
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Zip | 60160-3718
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Country | US
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Telephone | 708-344-5437
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Fax | 708-344-2757
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FLOR D. LOYA-COSTABILE
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Credential | DDS
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Telephone | 708-344-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019022347
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 021001646
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License Number State | IL
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