MEDICARE: JEFFREY THOMAS LOFTUS DDS PC

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	1223G0001X	General Practice Dentistry	M866	SD

General Provider Information

NPI Number	:	1699792887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY THOMAS LOFTUS DDS PC

Provider Business Mailing Address
First Line	:	5615 NUGGET GULCH DRIVE
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702
Country	:	US
Telephone Number	:	605-341-4521
Fax Number	:	605-341-9750

Provider Business Practice Location Address
First Line	:	5615 NUGGET GULCH DRIVE
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702
Country	:	US
Telephone Number	:	605-341-4521
Fax Number	:	605-341-9750

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. JEFFREY THOMAS LOFTUS
Credential	:	DDS
Telephone Number	:	605-341-4521

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	10/24/2016

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