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General NPI Number Information
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NPI Number | 1841628310
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Entity Type | Organization
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Legal Business Name | DEAN LODDING SMILES, LTD
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Dates
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Enumeration Date | 10/21/2013
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Last Update Date | 10/21/2013
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Provider Practice Location Address
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Address Line | 2001 LARKIN AVE STE 120
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City | ELGIN
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State | IL
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Zip | 60123-5808
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Country | US
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Telephone | 847-697-1111
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Fax | 847-697-1114
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Provider Business Mailing Address
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Address Line | 2001 LARKIN AVENUE, SUITE 120
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City | ELGIN
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State | IL
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Zip | 60123
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Country | US
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Telephone | 847-697-1111
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Fax | 847-697-1114
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEAN W LODDING
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Credential | DDS
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Telephone | 847-697-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019017360
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License Number State | IL
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