Eric Todd Loberg, D.D.S.
Individual provider Active NPI General Practice Dentistry · Lakewood, WI
NPI 1649273285 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1649273285
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 5234-015 (WI)
- Practice address
- 15397 State Highway 32
Lakewood, WI 54138-9702 - Phone
- (715) 276-6321
- Fax
- (715) 276-1428
- NPI assigned
- May 27, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150604001856 | WI | Order and Referring Only - Oral Surgery |
8527389394 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5234-015 | WI | Yes |
Addresses
Primary practice location
15397 State Highway 32
Lakewood, WI 54138-9702
Mailing address
1907 Dexter St
New London, WI 54961-2523
Phone (920) 531-1479
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 337-63800 | Medicaid | WI |
Other providers in Lakewood, WI
- Ted A Jung
- Patricia Ann Kender
- Min Kim
- Stacie M Kramer
- Lakewood Assisted Living, LLC
- Derek Loch
- Jodi Marie Marsh
- Lori Lee Nelson
- Nicolet Pharmacy Inc
- Nicolet Pharmacy Long Term Care
All providers in Lakewood, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.