Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 11710 | NC |
N | 1223E0200X | Endodontist | 3651 | WV |
NPI | 1073780284 |
---|---|
Provider Name | Dr. Michael Blaine Loftis |
First Address | Charleston, WV 25360-0623 |
Second Address | Greenville, NC 27834-5762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2008 |
Last Update Date | 08/04/2021 |