Provider Demographics
NPI:1942280912
Name:DONN R LIDINGTON DDS INC
Entity Type:Organization
Organization Name:DONN R LIDINGTON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:DONN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-935-8311
Mailing Address - Street 1:500 E HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-1685
Mailing Address - Country:US
Mailing Address - Phone:419-935-8311
Mailing Address - Fax:419-935-0812
Practice Address - Street 1:500 E HOWARD ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-1685
Practice Address - Country:US
Practice Address - Phone:419-935-8311
Practice Address - Fax:419-935-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14257261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0230995Medicaid