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General NPI Number Information
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NPI Number | 1265866206
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Entity Type | Organization
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Legal Business Name | PATRICK J HONSA DDS
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 3330 181ST PL SUITE 201
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City | LANSING
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State | IL
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Zip | 60438-2300
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Country | US
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Telephone | 708-865-3460
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Fax | 708-895-6560
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Provider Business Mailing Address
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Address Line | 3330 181ST PL SUITE 201
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City | LANSING
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State | IL
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Zip | 60438-2300
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Country | US
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Telephone | 708-865-3460
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Fax | 708-895-6560
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Authorized Official
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Title or Position | CEO
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Name | DR. PATRICK JEAN HONSA
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Credential | D.D.S
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Telephone | 708-895-3460
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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 | 019015428
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License Number State | IL
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