Provider Demographics
NPI:1497099501
Name:DWIGHT W. LOUDON DDS PC
Entity Type:Organization
Organization Name:DWIGHT W. LOUDON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LOUDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-338-7411
Mailing Address - Street 1:3005 S PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-5720
Mailing Address - Country:US
Mailing Address - Phone:605-338-7411
Mailing Address - Fax:605-338-6368
Practice Address - Street 1:3005 S PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5720
Practice Address - Country:US
Practice Address - Phone:605-338-7411
Practice Address - Fax:605-338-6368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM691261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental