Provider Demographics
NPI:1508139635
Name:LAGO, JAMES B (DDS/MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:LAGO
Suffix:
Gender:M
Credentials:DDS/MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 S. PROSPECT
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5014
Mailing Address - Country:US
Mailing Address - Phone:847-823-3441
Mailing Address - Fax:
Practice Address - Street 1:3 S. PROSPECT
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5014
Practice Address - Country:US
Practice Address - Phone:847-823-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021144122300000X, 204E00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services