Provider Demographics
NPI:1477625085
Name:ABROMAITIS, EDWARDS WALTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARDS
Middle Name:WALTER
Last Name:ABROMAITIS
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 1:801 STATE ST
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-3932
Mailing Address - Country:US
Mailing Address - Phone:630-257-5955
Mailing Address - Fax:
Practice Address - Street 1:801 STATE ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-3932
Practice Address - Country:US
Practice Address - Phone:630-257-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A145101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL19A14510OtherSTATE LICENSE NUMBER