Healthcare Provider Details

I. General information

NPI: 1841628310
Provider Name (Legal Business Name): DEAN LODDING SMILES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 LARKIN AVE STE 120
ELGIN IL
60123-5808
US

IV. Provider business mailing address

2001 LARKIN AVENUE, SUITE 120
ELGIN IL
60123
US

V. Phone/Fax

Practice location:
  • Phone: 847-697-1111
  • Fax: 847-697-1114
Mailing address:
  • Phone: 847-697-1111
  • Fax: 847-697-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019017360
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. DEAN W LODDING
Title or Position: OWNER
Credential: DDS
Phone: 847-697-1111