Provider Demographics
NPI:1821377615
Name:MCDERMOTT, LANA WICKS (DDS)
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:WICKS
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:LANA
Other - Middle Name:CATHERINE
Other - Last Name:WICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101
Mailing Address - Country:US
Mailing Address - Phone:563-382-3657
Mailing Address - Fax:563-382-0739
Practice Address - Street 1:108 5TH AVE
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101
Practice Address - Country:US
Practice Address - Phone:563-382-3657
Practice Address - Fax:563-382-0739
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice