Healthcare Provider Details

I. General information

NPI: 1952212631
Provider Name (Legal Business Name): LSQ DENTAL SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N LAKEVIEW AVE APT 1102
CHICAGO IL
60614-1818
US

IV. Provider business mailing address

2500 N LAKEVIEW AVE APT 1102
CHICAGO IL
60614-1818
US

V. Phone/Fax

Practice location:
  • Phone: 630-312-9609
  • Fax:
Mailing address:
  • Phone: 630-312-9609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY ROMAN
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 630-312-9609