Provider Demographics
NPI:1366637902
Name:LE, LAUREN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:H
Last Name:LE
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 1:1276 N CLYBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2003
Mailing Address - Country:US
Mailing Address - Phone:312-337-1073
Mailing Address - Fax:312-337-7616
Practice Address - Street 1:1276 N CLYBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2003
Practice Address - Country:US
Practice Address - Phone:312-337-1073
Practice Address - Fax:312-337-7616
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-024555122300000X
IL019024555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist