Provider Demographics
NPI:1720023682
Name:BARTUSIAK, LUCJAN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUCJAN
Middle Name:J
Last Name:BARTUSIAK
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 1:4625 LOCUST AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025
Mailing Address - Country:US
Mailing Address - Phone:773-405-4606
Mailing Address - Fax:
Practice Address - Street 1:1057 N. NORTHWEST HIGHWAY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-518-1057
Practice Address - Fax:847-518-1067
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190067121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice