Provider Demographics
NPI:1942458443
Name:DONALD A LA PIDUS DDS
Entity Type:Organization
Organization Name:DONALD A LA PIDUS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ABBY
Authorized Official - Last Name:LA PIDUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-432-2737
Mailing Address - Street 1:1770 FIRST ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3237
Mailing Address - Country:US
Mailing Address - Phone:847-432-2737
Mailing Address - Fax:847-432-2363
Practice Address - Street 1:1770 FIRST ST
Practice Address - Street 2:SUITE 430
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3237
Practice Address - Country:US
Practice Address - Phone:847-432-2737
Practice Address - Fax:847-432-2363
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONALD A LA PIDUS DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190120531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty