Lakeshore Dental, Inc.
Organization Active NPI Dentist · Glencoe, IL
NPI 1346540119 · NPPES record last updated Oct 27, 2010
Key facts
- NPI
- 1346540119
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- License
- 019020613 (IL)
- Legal business name
- LAKESHORE DENTAL, INC.
- Practice address
- 630 Vernon Ave
Suite C
Glencoe, IL 60022-1681 - Phone
- (847) 835-1450
- Fax
- (847) 835-0628
- NPI assigned
- Oct 27, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Michael Bobrow, DDS
- Title
- Owner
- Phone
- (847) 835-1450
Practitioners 1
-
Michael P Bobrow, DDS
National Provider Directory
Locations
630 Vernon Ave
Ste C
Glencoe, IL 60022
Phone (847) 835-1450
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | 019020613 | IL | Yes |
Addresses
Primary practice location
630 Vernon Ave
Suite C
Glencoe, IL 60022-1681
Mailing address
630 Vernon Ave
Suite C
Glencoe, IL 60022-1681
Phone (847) 835-1450
Other providers in Glencoe, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.