Provider Demographics
NPI:1407593924
Name:AUSTIN LACKE DMD PLLC
Entity Type:Organization
Organization Name:AUSTIN LACKE DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-200-9222
Mailing Address - Street 1:1852 FREDERICKSBURG LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-3647
Mailing Address - Country:US
Mailing Address - Phone:630-200-9222
Mailing Address - Fax:
Practice Address - Street 1:1852 FREDERICKSBURG LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60503-3647
Practice Address - Country:US
Practice Address - Phone:630-200-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental