Provider Demographics
NPI:1134126725
Name:DINGMAN, TODD ALAN (DDS,MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALAN
Last Name:DINGMAN
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W FOREST AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1482
Mailing Address - Country:US
Mailing Address - Phone:928-773-2530
Mailing Address - Fax:928-773-2532
Practice Address - Street 1:77 W FOREST AVE
Practice Address - Street 2:STE 107
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1482
Practice Address - Country:US
Practice Address - Phone:928-773-2530
Practice Address - Fax:928-773-2532
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ460600Medicaid
AZ460600Medicaid