=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659766673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAUREN E. SCHULTZ, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2015
-----------------------------------------------------
Last Update Date | 04/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 933 N NORTHWEST HWY 300
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-698-1199
-----------------------------------------------------
Fax | 847-655-6785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 933 N NORTHWEST HWY 300
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-698-1199
-----------------------------------------------------
Fax | 847-655-6785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LAUREN SCHULTZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 847-698-1199
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 019.028709
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------