Organization
LISA L. LOFTIS, D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA LYNN LOFTIS D.D.S. (OWNER)
(501) 332-4979
Entity
Organization
Contact information
Practice address
306 S ASH ST, MALVERN, AR 72104-3918
(501) 332-4979
(501) 337-7097
Mailing address
306 S ASH ST, MALVERN, AR 72104-3918
(501) 332-4979
(501) 337-7097
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
2905
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03090017900
QUAL CHOICE
—
01
—
58744
BLUECROSS BLUESHIELD FED
—
01
—
831360
UNITED CONCORDIA
—
Enumeration date
09/27/2006
Last updated
08/22/2020
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