Provider Demographics
NPI:1861401077
Name:LOOMIS, CHRISTOPHER B (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:B
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4759
Mailing Address - Country:US
Mailing Address - Phone:406-457-8928
Mailing Address - Fax:406-457-8981
Practice Address - Street 1:907 HELENA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3425
Practice Address - Country:US
Practice Address - Phone:406-422-4990
Practice Address - Fax:406-442-4939
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT97051223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT9705OtherMONTANA DENTAL LICENSE
MT9705OtherMONTANA DENTAL LICENSE
IDCS11324OtherST BOARD PHARMACY
ID3911OtherIDAHO DENTAL LICENSE
MT9705OtherMONTANA DENTAL LICENSE