Individual provider Active NPI

Daniel J. Loban, DDS

  • Dentist
  • Decatur, IL
National Provider Identifier
1073693883
Registry record updated Aug 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D11794 Issued in MN
Practice address
301 W North St
Decatur, IL 62522-2223
Phone
(217) 423-2400
NPI assigned
Oct 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D11794 MN Primary
Dentist 122300000X IL

Addresses

Primary practice location

301 W North St
Decatur, IL 62522-2223

Mailing address

301 W North St
Decatur, IL 62522-2223
Phone (217) 423-2400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160412002385 MN Order and Referring Only - DentistPractitioner - Dentist 8921306770

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019.027482ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Daniel J Loban DDS PA Dentist PastSince Nov 27, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187568000000",
    "number": "1073693883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 W NORTH ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625222223",
            "telephone_number": "217-423-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W NORTH ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625222223",
            "telephone_number": "217-423-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOBAN",
        "first_name": "DANIEL",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D11794",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

Verify at the official NPI Registry.