Healthcare Provider Details

I. General information

NPI: 1609907013
Provider Name (Legal Business Name): LILLIAN OBUCINA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S MICHIGAN AVE 727
CHICAGO IL
60603-5902
US

IV. Provider business mailing address

253 E DELAWARE PL 20F
CHICAGO IL
60611-1758
US

V. Phone/Fax

Practice location:
  • Phone: 312-909-2839
  • Fax: 888-676-3674
Mailing address:
  • Phone: 312-909-2839
  • Fax: 888-676-3674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019021263
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: