Provider Demographics
NPI:1790854024
Name:LANE, GREGORY LAPSANSKY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LAPSANSKY
Last Name:LANE
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 1:940 W ARMY TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-9068
Mailing Address - Country:US
Mailing Address - Phone:630-830-8330
Mailing Address - Fax:630-830-8330
Practice Address - Street 1:940 W ARMY TRAIL RD
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-9068
Practice Address - Country:US
Practice Address - Phone:630-830-8330
Practice Address - Fax:630-830-8330
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAL2829705OtherDEA REGISTRATION