Provider Demographics
NPI:1821246349
Name:LESNER, LOREN L (DDS)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:L
Last Name:LESNER
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 1:3232 RIDGE RD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438
Mailing Address - Country:US
Mailing Address - Phone:708-895-1200
Mailing Address - Fax:708-895-1200
Practice Address - Street 1:3232 RIDGE RD
Practice Address - Street 2:SUITE #6
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438
Practice Address - Country:US
Practice Address - Phone:708-895-1200
Practice Address - Fax:708-895-1200
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19015614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist