Provider Demographics
NPI:1043656929
Name:LAUREN A WEITZ DDS IN
Entity Type:Organization
Organization Name:LAUREN A WEITZ DDS IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-372-1700
Mailing Address - Street 1:1118 W SCHICK RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-3007
Mailing Address - Country:US
Mailing Address - Phone:630-372-1700
Mailing Address - Fax:630-372-1703
Practice Address - Street 1:1118 W SCHICK RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-3007
Practice Address - Country:US
Practice Address - Phone:630-372-1700
Practice Address - Fax:630-372-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.026806122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty