Provider Demographics
NPI:1740279231
Name:LOIBEN, DONALD PHILIP (DDS)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:PHILIP
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 1:6517 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-3430
Mailing Address - Country:US
Mailing Address - Phone:773-434-2433
Mailing Address - Fax:847-673-4408
Practice Address - Street 1:6517 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-3430
Practice Address - Country:US
Practice Address - Phone:773-434-2433
Practice Address - Fax:847-673-4408
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist