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General NPI Number Information
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NPI Number | 1952212631
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Entity Type | Organization
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Legal Business Name | LSQ DENTAL SPECIALISTS LLC
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 2500 N LAKEVIEW AVE APT 1102
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City | CHICAGO
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State | IL
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Zip | 60614-1818
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Country | US
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Telephone | 630-312-9609
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 N LAKEVIEW AVE APT 1102
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City | CHICAGO
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State | IL
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Zip | 60614-1818
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Country | US
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Telephone | 630-312-9609
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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. MARY ROMAN
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Credential | DDS, MS
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Telephone | 630-312-9609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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