Provider Demographics
NPI:1245227867
Name:ZAGER, LAWRENCE H (DDS)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:H
Last Name:ZAGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E WASHINGTON ST
Mailing Address - Street 2:# 825
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1708
Mailing Address - Country:US
Mailing Address - Phone:312-372-0411
Mailing Address - Fax:312-372-0428
Practice Address - Street 1:25 E WASHINGTON ST
Practice Address - Street 2:# 825
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1708
Practice Address - Country:US
Practice Address - Phone:312-372-0411
Practice Address - Fax:312-372-0428
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210010941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
433159OtherUNITED CONCORDIA
80006190OtherBCBS
696790Medicare ID - Type Unspecified
T37951Medicare UPIN