Provider Demographics
NPI:1669699880
Name:LINCOLN PARK DENTAL SPECIALISTS
Entity type:Organization
Organization Name:LINCOLN PARK DENTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEDE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSH
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:773-327-3131
Mailing Address - Street 1:1960 N LINCOLN PARK W
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5487
Mailing Address - Country:US
Mailing Address - Phone:773-327-3131
Mailing Address - Fax:773-327-3208
Practice Address - Street 1:1960 N LINCOLN PARK W
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5487
Practice Address - Country:US
Practice Address - Phone:773-327-3131
Practice Address - Fax:773-327-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty