Provider Demographics
NPI:1861549990
Name:CANBY, FREDERICK LOOMIS (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:LOOMIS
Last Name:CANBY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2 CARDINAL PARK DR SE
Mailing Address - Street 2:STE 106A
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4448
Mailing Address - Country:US
Mailing Address - Phone:703-779-7900
Mailing Address - Fax:703-779-7903
Practice Address - Street 1:2 CARDINAL PARK DR SE
Practice Address - Street 2:STE 106A
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4448
Practice Address - Country:US
Practice Address - Phone:703-779-7900
Practice Address - Fax:703-779-7903
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010084771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics