Basic Information
| Provider Information | |||||||||
| NPI: | 1922090695 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOONEY | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 317 CRESTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744648035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184581815 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19600 E ROSS ST | ||||||||
| Address2: | |||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744640545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5392341000 | ||||||||
| FaxNumber: | 9184531339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 5772 | OK | Y | Dental Providers | Dentist |
No ID Information.