Provider Demographics
NPI:1881869279
Name:LOZOFF, ROBERT EVAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EVAN
Last Name:LOZOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 SHERIDAN RD
Mailing Address - Street 2:302
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-4703
Mailing Address - Country:US
Mailing Address - Phone:720-317-8421
Mailing Address - Fax:
Practice Address - Street 1:515 SHERIDAN RD
Practice Address - Street 2:302
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-4703
Practice Address - Country:US
Practice Address - Phone:720-317-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0293281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41120086Medicaid