Provider Demographics
NPI:1356461529
Name:LICHTENSTEIN, HOWARD M (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:M
Last Name:LICHTENSTEIN
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 1:9103 POTTAWATTAMI DR
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1911
Mailing Address - Country:US
Mailing Address - Phone:847-676-3752
Mailing Address - Fax:
Practice Address - Street 1:11312 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-2002
Practice Address - Country:US
Practice Address - Phone:708-448-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist