Provider Demographics
NPI:1619056025
Name:LOIBEN, THEODORE (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:LOIBEN
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 1:123 MCHENRY RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1796
Mailing Address - Country:US
Mailing Address - Phone:847-459-9100
Mailing Address - Fax:847-459-9195
Practice Address - Street 1:123 MCHENRY RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1796
Practice Address - Country:US
Practice Address - Phone:847-459-9100
Practice Address - Fax:847-459-9195
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry