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General NPI Number Information
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NPI Number | 1083738322
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Entity Type | Individual
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Provider Name | TERRY T DINGBAUM DDS
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 6825 E TENNESSEE AVE STE 621
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City | DENVER
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State | CO
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Zip | 80224-1634
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Country | US
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Telephone | 303-333-2221
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 W US ROUTE 6
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City | MORRIS
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State | IL
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Zip | 60450-8942
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Country | US
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Telephone | 815-942-0010
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Fax | 815-942-0692
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019-021819
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License Number State | IL
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