Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 18880 | OH |
NPI | 1063479012 |
---|---|
Provider Name | Dr. Richard M Loochtan, D.d.s., M.s. |
First Address | Pickerington, OH 43147 |
Second Address | Pickerington, OH 43147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 25/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0819127 | (05) | OH |