Provider Demographics
NPI:1205034618
Name:FOURDYCE, LANA SAVOIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANA
Middle Name:SAVOIE
Last Name:FOURDYCE
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 1:909 W WASHINGTON BLVD
Mailing Address - Street 2:901
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2204
Mailing Address - Country:US
Mailing Address - Phone:773-392-5548
Mailing Address - Fax:
Practice Address - Street 1:127 AURORA AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6503
Practice Address - Country:US
Practice Address - Phone:630-579-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190273801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice