Provider Demographics
NPI:1447380621
Name:PRAIRIE DENTAL LTD.
Entity Type:Organization
Organization Name:PRAIRIE DENTAL LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LUKAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-439-8500
Mailing Address - Street 1:23959 W RENWICK RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2108
Mailing Address - Country:US
Mailing Address - Phone:815-439-8500
Mailing Address - Fax:815-439-9214
Practice Address - Street 1:23959 W RENWICK RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2108
Practice Address - Country:US
Practice Address - Phone:815-439-8500
Practice Address - Fax:815-439-9214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty