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LOFTUS FAMILY DENTAL

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Company Details

Name: LOFTUS FAMILY DENTAL
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 20 Jan 2004 (21 years ago)
Entity Number: 227258
Place of Formation: IDAHO
File Number: 0000227258
ZIP code: 83815
County: Kootenai County
Mailing Address: 2615 FRUITLAND LN COEUR D ALENE, ID 83815

National Provider Identifier

NPI Number:
1740661388

Authorized Person:

Name:
DR. GUADALUPE GUTIERREZ
Role:
DENTIST
Phone:

Taxonomy:

Selected Taxonomy:
305S00000X - Point of Service
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Legacy Amendment 0000808853 2011-12-13
Initial Filing 0000227258 2004-01-20

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Date of last update: 24 Sep 2024

Sources: Idaho Secretary of State