Healthcare Provider Details

I. General information

NPI: 1942280912
Provider Name (Legal Business Name): DONN R LIDINGTON DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E HOWARD ST
WILLARD OH
44890-1685
US

IV. Provider business mailing address

500 E HOWARD ST
WILLARD OH
44890-1685
US

V. Phone/Fax

Practice location:
  • Phone: 419-935-8311
  • Fax: 419-935-0812
Mailing address:
  • Phone: 419-935-8311
  • Fax: 419-935-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number14257
License Number StateOH

VIII. Authorized Official

Name: DR. DONN R LIDINGTON
Title or Position: PRES.
Credential: DDS
Phone: 419-935-8311