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General NPI Number Information
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NPI Number | 1295909240
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Entity Type | Organization
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Legal Business Name | M LAUCK SC
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Dates
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Enumeration Date | 04/19/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 360 W BUTTERFIELD RD SUITE 220
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City | ELMHURST
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State | IL
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Zip | 60126-5068
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Country | US
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Telephone | 630-833-0395
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Fax |
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Provider Business Mailing Address
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Address Line | 360 W BUTTERFIELD RD SUITE 220
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City | ELMHURST
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State | IL
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Zip | 60126-5068
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Country | US
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Telephone | 630-833-0395
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL JAMES LAUCK
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Credential | D.D.S.
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Telephone | 630-833-0395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 019013525
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License Number State | IL
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