Provider Demographics
NPI:1306152806
Name:LODHI, TANIA G (DDS)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:G
Last Name:LODHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1411
Mailing Address - Country:US
Mailing Address - Phone:217-204-9025
Mailing Address - Fax:
Practice Address - Street 1:1902 N PROSPECT AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1411
Practice Address - Country:US
Practice Address - Phone:217-204-9025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0289601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice