Healthcare Provider Details

I. General information

NPI: 1497780555
Provider Name (Legal Business Name): LEWIS L LANDSMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DENTAL SERVICE (160) 5TH & ROOSEVELT
HINES IL
60141-5000
US

IV. Provider business mailing address

905 VILLAS CT
HIGHLAND PARK IL
60035-3703
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax: 708-202-2332
Mailing address:
  • Phone: 847-831-2883
  • Fax: 847-831-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: