Organization Name: | CHILDREN'S DENTISTRY OF LAKE COUNTY AND ASSOCIATES, P.C. |
NPI Number: | 1124245527 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTINE S LEE (PRESIDENT) |
Mailing Address: | 5250 Grand Ave Ste 7 Gurnee |
State: | IL US |
Postal Code: | 600311877 |
Phone Number: | 8476627755 |
Fax Number: | 8476627723 |
NPI Enumeration Date: | 04/19/2007 |
NPI Last Update Date: | 08/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 021001782 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |