Provider Demographics
NPI:1265560593
Name:CASIMIR, LENA JUDITH (DDS)
Entity type:Individual
Prefix:DR
First Name:LENA
Middle Name:JUDITH
Last Name:CASIMIR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10409 WHITE OAK LN
Mailing Address - Street 2:#3-D
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3897
Mailing Address - Country:US
Mailing Address - Phone:219-730-6265
Mailing Address - Fax:312-663-1895
Practice Address - Street 1:828 S WABASH AVE
Practice Address - Street 2:SUITE # 250
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2181
Practice Address - Country:US
Practice Address - Phone:312-922-3411
Practice Address - Fax:312-663-1895
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9178901Medicaid