Provider Demographics
NPI:1790146132
Name:FAMILY MILLENNIUM DENTISTRY, INC.
Entity Type:Organization
Organization Name:FAMILY MILLENNIUM DENTISTRY, INC.
Other - Org Name:MILLENNIUM DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:312-767-0407
Mailing Address - Street 1:1342 W RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1522
Mailing Address - Country:US
Mailing Address - Phone:312-767-0407
Mailing Address - Fax:312-988-0292
Practice Address - Street 1:1342 W RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1522
Practice Address - Country:US
Practice Address - Phone:312-767-0407
Practice Address - Fax:312-988-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-13
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210010941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty