Provider Demographics
NPI:1083738322
Name:DINGBAUM, TERRY T (DDS)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:T
Last Name:DINGBAUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W US ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-8942
Mailing Address - Country:US
Mailing Address - Phone:815-942-0010
Mailing Address - Fax:815-942-0692
Practice Address - Street 1:6825 E TENNESSEE AVE STE 621
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1634
Practice Address - Country:US
Practice Address - Phone:303-333-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0218191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice