Active NPI
Grant Quan Loo, DMD
- General Practice Dentistry
- Martinez, GA
National Provider Identifier
1972667806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10962
- Practice address
- 224 Baston Rd
Martinez, GA 30907-2976 - Phone
- (706) 868-1722
- Fax
- (706) 868-9516
- NPI assigned
- Dec 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10962 | GA | Primary |
Addresses
Primary practice location
224 Baston Rd
Martinez, GA 30907-2976
Mailing address
224 Baston Rd
Martinez, GA 30907-2976
Phone (706) 868-1722
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10962 | GA | MD | Cardiovascular Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341964800000",
"number": "1972667806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "224 BASTON RD",
"city": "MARTINEZ",
"state": "GA",
"postal_code": "309072976",
"telephone_number": "706-868-1722",
"fax_number": "706-868-9516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "224 BASTON RD",
"city": "MARTINEZ",
"state": "GA",
"postal_code": "309072976",
"telephone_number": "706-868-1722",
"fax_number": "706-868-9516"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOO",
"first_name": "GRANT",
"middle_name": "QUAN",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-22",
"last_updated": "2012-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "10962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Martinez, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.