Provider Demographics
NPI:1639658917
Name:WEBSTER DENTAL CARE SAUGANASH, LTD
Entity Type:Organization
Organization Name:WEBSTER DENTAL CARE SAUGANASH, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-685-9666
Mailing Address - Street 1:4801 W PETERSON AVE STE 316
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5726
Mailing Address - Country:US
Mailing Address - Phone:773-685-9666
Mailing Address - Fax:773-685-1967
Practice Address - Street 1:4801 W PETERSON AVE STE 316
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5726
Practice Address - Country:US
Practice Address - Phone:773-685-9666
Practice Address - Fax:773-685-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty