Provider Demographics
NPI:1790752038
Name:LAWN DENTAL CENTER
Entity Type:Organization
Organization Name:LAWN DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:OLONO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-523-0700
Mailing Address - Street 1:3113 SOUTH PULASKI
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623
Mailing Address - Country:US
Mailing Address - Phone:773-523-0700
Mailing Address - Fax:773-523-0702
Practice Address - Street 1:3113 SOUTH PULASKI
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623
Practice Address - Country:US
Practice Address - Phone:773-523-0700
Practice Address - Fax:773-523-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019895122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty