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General NPI Number Information
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NPI Number | 1902620495
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Entity Type | Organization
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Legal Business Name | LUMIERE DENTAL PLLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1959 W DIVISION ST
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City | CHICAGO
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State | IL
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Zip | 60622-3148
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Country | US
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Telephone | 312-471-6545
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Fax | 312-471-6546
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Provider Business Mailing Address
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Address Line | 1959 W DIVISION ST
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City | CHICAGO
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State | IL
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Zip | 60622-3148
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Country | US
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Telephone | 312-471-6545
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Fax | 312-471-6546
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Authorized Official
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Title or Position | DR.
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Name | RYAN CHRISTOPHER WOITAS
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Credential | DMD
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Telephone | 630-229-9877
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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 |
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License Number State |
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