Provider Demographics
NPI:1497780555
Name:LANDSMAN, LEWIS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:L
Last Name:LANDSMAN
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 1:905 VILLAS CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3703
Mailing Address - Country:US
Mailing Address - Phone:847-831-2883
Mailing Address - Fax:847-831-0551
Practice Address - Street 1:DENTAL SERVICE (160)
Practice Address - Street 2:5TH & ROOSEVELT
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5000
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-2332
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist