Mitchell Loo, DMD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

S2-199C Issued in NV

Practice address

2835 Saint Rose Pkwy Ste 100
Henderson, NV 89052-4847

Phone

(702) 900-4780

NPI assigned

Aug 10, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in HI, MA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pacific Maxillofacial Center, LLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Honolulu, HI
  • NPI 1003839069
  Medicare reassignment NPD
• Matthew Kikuchi DMD PLLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Las Vegas, NV
  • NPI 1780051367
  NPD (past)
• Pacific Maxillofacial Center, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Honolulu, HI
  • NPI 1518986579
  NPD (past)
• Robert P. Moskal DMD PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Franklin, MA
  • NPI 1104043579
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1487901336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 BOURET PL",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890123129",
            "telephone_number": "857-588-2085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 SAINT ROSE PKWY STE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890524847",
            "telephone_number": "702-900-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOO",
        "first_name": "MITCHELL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-10",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NV",
            "license": "S2-199C",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NV",
            "license": "S2-199C",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Keith Longhurst, DPT
• Altonya Aleika Longmore, BCBA, LBA
• Longs Drug Stores California LLC
• Longs Drug Stores California LLC
• Kayla K Lono
• Robert Lopees
• Sindya Keylan Lopez Cruz
• Juan Ramon Lopez Garcia
• Guadalupe Lopez Guiza, RBT
• Daniel Lopez Leon, RN

• Oral & Maxillofacial Surgery (D.M.D.) in Henderson, NV
• Providers in Henderson, NV by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.