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NPI Code Detail

MEDICARE: LAKELAND HILLS DENTAL PC

MEDICARE: LAKELAND HILLS DENTAL PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11318983OTHERILUCCI

General Provider Information

NPI Number : 1194735761
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKELAND HILLS DENTAL PC
Provider Business Mailing Address
First Line : 256 ARBOR MEADOWS COURT
Second Line :
City : FAIRVIEW HEIGHTS
State : IL
Zip : 62208-3419
Country : US
Telephone Number : 618-444-4665
Fax Number :
Provider Business Practice Location Address
First Line : 5011 N ILLINOIS
Second Line : SUITE 1
City : FAIRVIEW HEIGHTS
State : IL
Zip : 62208-3419
Country : US
Telephone Number : 618-222-1942
Fax Number :
Authorized Official
Title or Position : PRESIDENT/DENTIST
Name : WALTER J. JANKOWSKI
Credential :
Telephone Number : 618-222-1942
Provider Enumeration Date : 08/08/2006
Last Update Date : 08/22/2020

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Directions to “LAKELAND HILLS DENTAL PC ” Practice Location

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