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General NPI Number Information
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NPI Number | 1821121765
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Entity Type | Organization
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Legal Business Name | LARRY J LOEWEN DDS PC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20240 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48152-1412
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Country | US
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Telephone | 248-474-0100
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Fax | 248-474-1588
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Provider Business Mailing Address
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Address Line | 20240 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48152-1412
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Country | US
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Telephone | 248-474-0100
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Fax | 248-474-1588
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. LARRY J LOEWEN
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Credential | D.D.S
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Telephone | 248-474-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10559
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License Number State | MI
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