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General NPI Number Information
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NPI Number | 1043656929
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Entity Type | Organization
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Legal Business Name | LAUREN A WEITZ DDS IN
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Dates
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Enumeration Date | 05/17/2013
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 1118 W SCHICK RD
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City | BARTLETT
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State | IL
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Zip | 60103-3007
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Country | US
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Telephone | 630-372-1700
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Fax | 630-372-1703
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Provider Business Mailing Address
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Address Line | 1118 W SCHICK RD
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City | BARTLETT
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State | IL
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Zip | 60103-3007
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Country | US
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Telephone | 630-372-1700
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Fax | 630-372-1703
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. LAUREN A WEITZ
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Credential | D.D.S.
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Telephone | 630-372-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.026806
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License Number State | IL
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