Provider Demographics
NPI:1710045489
Name:BOMGAARS, LEE R (DDS)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:R
Last Name:BOMGAARS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:2634 GRAND AVE
Mailing Address - Street 2:#106
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2458
Mailing Address - Country:US
Mailing Address - Phone:847-662-7588
Mailing Address - Fax:847-662-3843
Practice Address - Street 1:2634 GRAND AVE
Practice Address - Street 2:#106
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2458
Practice Address - Country:US
Practice Address - Phone:847-662-7588
Practice Address - Fax:847-662-3843
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL210006371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry