Provider Demographics
NPI:1972215333
Name:GJECI, LOREN
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:GJECI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 LUDLOW ST APT 302
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5752
Mailing Address - Country:US
Mailing Address - Phone:347-249-6772
Mailing Address - Fax:
Practice Address - Street 1:9898 ROOSEVELT BLVD STE 107
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1730
Practice Address - Country:US
Practice Address - Phone:347-249-6772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS045388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program