Provider Demographics
NPI:1669752515
Name:FLOR D. LOYA DDS LTD
Entity type:Organization
Organization Name:FLOR D. LOYA DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FLOR
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOYA-COSTABILE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-344-5437
Mailing Address - Street 1:154 N 19TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-3718
Mailing Address - Country:US
Mailing Address - Phone:708-344-5437
Mailing Address - Fax:708-344-2757
Practice Address - Street 1:134 W VALLETTE ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-4451
Practice Address - Country:US
Practice Address - Phone:708-344-5437
Practice Address - Fax:708-344-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022347122300000X
IL0210016461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty