MEDICARE: DR. TIMOTHY J LOUGHRAN D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019-018163-1	IL

General Provider Information

NPI Number	:	1295734119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY J LOUGHRAN D.D.S

Provider Business Mailing Address
First Line	:	200 S 16TH ST
Second Line	:
City	:	HERRIN
State	:	IL
Zip	:	62948-2237
Country	:	US
Telephone Number	:	618-988-8130
Fax Number	:	618-942-2874

Provider Business Practice Location Address
First Line	:	200 S 16TH ST
Second Line	:
City	:	HERRIN
State	:	IL
Zip	:	62948-2237
Country	:	US
Telephone Number	:	618-988-8130
Fax Number	:	618-942-2874

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/08/2007

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