Provider Demographics
NPI:1346327897
Name:WAISMAN, LIONEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:A
Last Name:WAISMAN
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 1:403 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-2851
Mailing Address - Country:US
Mailing Address - Phone:630-830-1954
Mailing Address - Fax:630-830-2049
Practice Address - Street 1:403 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-2851
Practice Address - Country:US
Practice Address - Phone:630-830-1954
Practice Address - Fax:630-830-2049
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice