Provider Demographics
NPI:1245544907
Name:LINCOLN DENTAL GROUP
Entity type:Organization
Organization Name:LINCOLN DENTAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-360-3333
Mailing Address - Street 1:2226 N LINCOLN AVE
Mailing Address - Street 2:1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6247
Mailing Address - Country:US
Mailing Address - Phone:773-360-3333
Mailing Address - Fax:
Practice Address - Street 1:2226 N LINCOLN AVE
Practice Address - Street 2:1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6247
Practice Address - Country:US
Practice Address - Phone:773-360-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190262401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty