Provider Demographics
NPI:1922262518
Name:LUKAWSKI, PAUL ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTHONY
Last Name:LUKAWSKI
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 1:23909 W RENWICK RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2108
Mailing Address - Country:US
Mailing Address - Phone:815-439-8500
Mailing Address - Fax:815-439-9214
Practice Address - Street 1:23909 W RENWICK RD
Practice Address - Street 2:SUITE 111
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2108
Practice Address - Country:US
Practice Address - Phone:815-439-8500
Practice Address - Fax:815-439-9214
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-021736122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
364381069OtherTAX ID