Healthcare Provider Details

I. General information

NPI: 1457694853
Provider Name (Legal Business Name): LONN E BRANDER DDS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 HAUSER ROSS DR STE 300
SYCAMORE IL
60178-3179
US

IV. Provider business mailing address

2550 HAUSER ROSS DR STE 300
SYCAMORE IL
60178-3179
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-2295
  • Fax:
Mailing address:
  • Phone: 815-756-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019-022322
License Number StateIL

VIII. Authorized Official

Name: DR. LONN EDWARD BRANDER
Title or Position: DENTIST/ OWNER
Credential: DDS
Phone: 815-756-2295