Provider Demographics
NPI:1427597368
Name:LILLIAN OBUCINA DDS PC
Entity Type:Organization
Organization Name:LILLIAN OBUCINA DDS PC
Other - Org Name:LAKEFRONT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBUCINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-505-2918
Mailing Address - Street 1:111 NORTH WABASH
Mailing Address - Street 2:SUITE 1522
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60202
Mailing Address - Country:US
Mailing Address - Phone:312-909-2839
Mailing Address - Fax:
Practice Address - Street 1:111 NORTH WABASH
Practice Address - Street 2:SUITE 1522
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60202
Practice Address - Country:US
Practice Address - Phone:312-909-2839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021263122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty