Provider Demographics
NPI:1225733603
Name:LODIN, RYLIE
Entity Type:Individual
Prefix:
First Name:RYLIE
Middle Name:
Last Name:LODIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7228 OAKENSHAW DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2764
Mailing Address - Country:US
Mailing Address - Phone:317-313-6824
Mailing Address - Fax:
Practice Address - Street 1:497 W BUTTERNUT RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-5585
Practice Address - Country:US
Practice Address - Phone:843-970-7299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC105211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice