Provider Demographics
NPI:1497839344
Name:LODDING, DEAN W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:W
Last Name:LODDING
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 1:2001 LARKIN AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5808
Mailing Address - Country:US
Mailing Address - Phone:847-697-1111
Mailing Address - Fax:847-697-1114
Practice Address - Street 1:2001 LARKIN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5808
Practice Address - Country:US
Practice Address - Phone:847-697-1111
Practice Address - Fax:847-697-1114
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice