Provider Demographics
NPI:1952856155
Name:LIGHTHOUSE DENTAL INC
Entity Type:Organization
Organization Name:LIGHTHOUSE DENTAL INC
Other - Org Name:JOY FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUN-HEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:224-578-1300
Mailing Address - Street 1:990 GRAND CANYON PKWY
Mailing Address - Street 2:SUITE #110
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1739
Mailing Address - Country:US
Mailing Address - Phone:847-885-9954
Mailing Address - Fax:847-885-8633
Practice Address - Street 1:990 GRAND CANYON PKWY
Practice Address - Street 2:SUITE #110
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1739
Practice Address - Country:US
Practice Address - Phone:847-885-9954
Practice Address - Fax:847-885-8633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty