Provider Demographics
NPI:1184708042
Name:LOY DENTISTRY, PSC
Entity type:Organization
Organization Name:LOY DENTISTRY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARROLL
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-784-6631
Mailing Address - Street 1:255 BEACON HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-6030
Mailing Address - Country:US
Mailing Address - Phone:606-784-6631
Mailing Address - Fax:606-780-7582
Practice Address - Street 1:255 BEACON HILL RD
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-6030
Practice Address - Country:US
Practice Address - Phone:606-784-6631
Practice Address - Fax:606-780-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6742122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty