Provider Demographics
NPI:1578620670
Name:LEHTMAN, CRAIG DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:DOUGLAS
Last Name:LEHTMAN
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 1:708 CHURCH STREET
Mailing Address - Street 2:SUITE 209
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-328-0011
Mailing Address - Fax:847-328-0795
Practice Address - Street 1:708 CHURCH STREET
Practice Address - Street 2:SUITE 209
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-328-0011
Practice Address - Fax:847-328-0795
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice