Provider Demographics
NPI:1932283462
Name:LODL, JACALYN R (RDH)
Entity Type:Individual
Prefix:
First Name:JACALYN
Middle Name:R
Last Name:LODL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JACALYN
Other - Middle Name:R
Other - Last Name:OLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:660 BANNOCK ST
Mailing Address - Street 2:MC 1914
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4506
Mailing Address - Country:US
Mailing Address - Phone:303-436-5106
Mailing Address - Fax:303-436-5093
Practice Address - Street 1:660 BANNOCK ST
Practice Address - Street 2:MC 1914
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4506
Practice Address - Country:US
Practice Address - Phone:303-436-5106
Practice Address - Fax:303-436-5093
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH00003035124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist