| Organization Name: | LAKE COOK DENTAL CENTER |
| NPI Number: | 1487992327 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROSE M LESNIAK (PRESIDENT) |
| Mailing Address: | 115 W Orchard St Itasca |
| State: | IL US |
| Postal Code: | 601431700 |
| Phone Number: | 8472505580 |
| Fax Number: | |
| NPI Enumeration Date: | 01/28/2013 |
| NPI Last Update Date: | 01/28/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | 019025184 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |