Provider Demographics
NPI:1598938409
Name:LODMELL, ANTON MILES (DDS PS)
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:MILES
Last Name:LODMELL
Suffix:
Gender:M
Credentials:DDS PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E BIRCH ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3054
Mailing Address - Country:US
Mailing Address - Phone:509-525-2923
Mailing Address - Fax:509-529-9730
Practice Address - Street 1:120 E BIRCH ST
Practice Address - Street 2:SUITE #5
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3054
Practice Address - Country:US
Practice Address - Phone:509-525-2923
Practice Address - Fax:509-529-9730
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice