Provider Demographics
NPI:1356351985
Name:LOOMIS, DONALD J (DDS)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-1349
Mailing Address - Country:US
Mailing Address - Phone:608-222-7181
Mailing Address - Fax:608-222-2078
Practice Address - Street 1:4801 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-1349
Practice Address - Country:US
Practice Address - Phone:608-222-7181
Practice Address - Fax:608-222-2078
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000 2541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice