Provider Demographics
NPI:1649203878
Name:DOHAN, L MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:L
Middle Name:MICHAEL
Last Name:DOHAN
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 1:115 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2812
Mailing Address - Country:US
Mailing Address - Phone:630-584-0026
Mailing Address - Fax:630-584-1109
Practice Address - Street 1:115 S 2ND ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2812
Practice Address - Country:US
Practice Address - Phone:630-584-0026
Practice Address - Fax:630-584-1109
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0169631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice