Provider Demographics
NPI:1003961012
Name:KORZENIOWSKI -LYON, EVA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:M
Last Name:KORZENIOWSKI -LYON
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 1:661 KENNINGTON TER
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2028
Mailing Address - Country:US
Mailing Address - Phone:847-530-1492
Mailing Address - Fax:
Practice Address - Street 1:420 LAKE COOK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5646
Practice Address - Country:US
Practice Address - Phone:847-444-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025216122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist