Provider Demographics
NPI:1568467702
Name:LOCKPORT DENTAL GROUP, LTD
Entity Type:Organization
Organization Name:LOCKPORT DENTAL GROUP, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:SLUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-838-6102
Mailing Address - Street 1:230 E 8TH ST
Mailing Address - Street 2:STE 5
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3081
Mailing Address - Country:US
Mailing Address - Phone:815-838-6102
Mailing Address - Fax:815-838-6281
Practice Address - Street 1:230 E 8TH ST
Practice Address - Street 2:STE 5
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3081
Practice Address - Country:US
Practice Address - Phone:815-838-6102
Practice Address - Fax:815-838-6281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
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