MEDICARE: DR. GORDON EDWARD DAMMANN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19-013584	IL

General Provider Information

NPI Number	:	1891957874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GORDON EDWARD DAMMANN DDS

Provider Business Mailing Address
First Line	:	123 W RAILROAD ST
Second Line	:	POBOX 516
City	:	LENA
State	:	IL
Zip	:	61048-9038
Country	:	US
Telephone Number	:	815-369-2611
Fax Number	:	815-369-2720

Provider Business Practice Location Address
First Line	:	123 W RAILROAD ST
Second Line	:
City	:	LENA
State	:	IL
Zip	:	61048-9038
Country	:	US
Telephone Number	:	815-369-2611
Fax Number	:	815-369-2720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/07/2026

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