Provider Demographics
NPI:1265866206
Name:PATRICK J HONSA DDS
Entity Type:Organization
Organization Name:PATRICK J HONSA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HONSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-895-3460
Mailing Address - Street 1:3330 181ST PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2300
Mailing Address - Country:US
Mailing Address - Phone:708-865-3460
Mailing Address - Fax:708-895-6560
Practice Address - Street 1:3330 181ST PL
Practice Address - Street 2:SUITE 201
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2300
Practice Address - Country:US
Practice Address - Phone:708-865-3460
Practice Address - Fax:708-895-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019015428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty