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General NPI Number Information
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NPI Number | 1720023682
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Entity Type | Individual
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Provider Name | LUCJAN J BARTUSIAK D.D.S
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Gender | Male
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 1057 N. NORTHWEST HIGHWAY
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City | PARK RIDGE
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State | IL
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Zip | 60068
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Country | US
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Telephone | 847-518-1057
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Fax | 847-518-1067
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Provider Business Mailing Address
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Address Line | 4625 LOCUST AVENUE
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City | GLENVIEW
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State | IL
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Zip | 60025
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Country | US
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Telephone | 773-405-4606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019006712
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License Number State | IL
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