Provider Demographics
NPI:1629489208
Name:NASSAR, LUTFI (DDS)
Entity Type:Individual
Prefix:
First Name:LUTFI
Middle Name:
Last Name:NASSAR
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 1:1425 MCHENRY RD STE 211
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1332
Mailing Address - Country:US
Mailing Address - Phone:847-913-5560
Mailing Address - Fax:847-913-5561
Practice Address - Street 1:1425 MCHENRY RD STE 211
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1332
Practice Address - Country:US
Practice Address - Phone:847-913-5560
Practice Address - Fax:847-913-5561
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.031000122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0127046Medicaid