Provider Demographics
NPI:1134299860
Name:DR. LAWRENCE R. FINE D.D.S. AND ASSOICATES, LTD.
Entity Type:Organization
Organization Name:DR. LAWRENCE R. FINE D.D.S. AND ASSOICATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-383-1234
Mailing Address - Street 1:840 S OAK PARK AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1220
Mailing Address - Country:US
Mailing Address - Phone:708-383-1234
Mailing Address - Fax:708-383-3578
Practice Address - Street 1:840 S OAK PARK AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1220
Practice Address - Country:US
Practice Address - Phone:708-383-1234
Practice Address - Fax:708-383-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty