Provider Demographics
NPI:1801002506
Name:SOSENKO, LYDIA M (DDS, ABDSM)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:M
Last Name:SOSENKO
Suffix:
Gender:F
Credentials:DDS, ABDSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N SHERMAN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8608
Mailing Address - Country:US
Mailing Address - Phone:630-369-5225
Mailing Address - Fax:630-369-7416
Practice Address - Street 1:1100 N SHERMAN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8608
Practice Address - Country:US
Practice Address - Phone:630-369-5225
Practice Address - Fax:630-369-7416
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist