MEDICARE: ELIZABETH LOFTUS DDS INC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1699474361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH LOFTUS DDS INC

Provider Business Mailing Address
First Line	:	3116 BOSTONIAN DR
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-4238
Country	:	US
Telephone Number	:	916-837-1761
Fax Number	:

Provider Business Practice Location Address
First Line	:	6413 E SPRING ST STE B-3
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-4022
Country	:	US
Telephone Number	:	916-837-1761
Fax Number	:

Authorized Official
Title or Position	:	OWNER, DENTIST
Name	:	DR. ELIZABETH LOFTUS
Credential	:
Telephone Number	:	916-837-1761

Provider Enumeration Date	:	03/01/2023
Last Update Date	:	03/01/2023

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