MEDICARE: DONALD A LA PIDUS DDS

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
1	1223G0001X	General Practice Dentistry	019012053	IL

General Provider Information

NPI Number	:	1942458443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD A LA PIDUS DDS

Provider Business Mailing Address
First Line	:	1770 FIRST ST
Second Line	:	SUITE 430
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-3237
Country	:	US
Telephone Number	:	847-432-2737
Fax Number	:	847-432-2363

Provider Business Practice Location Address
First Line	:	1770 FIRST ST
Second Line	:	SUITE 430
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-3237
Country	:	US
Telephone Number	:	847-432-2737
Fax Number	:	847-432-2363

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DR. DONALD ABBY LA PIDUS
Credential	:	DDS
Telephone Number	:	847-432-2737

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	09/09/2008

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