| Jacob S Lake Dds Ltd | |
|
15 E Dundee Rd Buffalo Grove IL 60089-4383 | |
| (847) 229-1700 | |
| (847) 229-1737 |
| Full Name | Jacob S Lake Dds Ltd |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 15 E Dundee Rd, Buffalo Grove, Illinois |
| Authorized Official Name and Position | Jacob S Lake (OWNER) |
| Authorized Official Contact | 8472291700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacob S Lake Dds Ltd 15 E. Dundee Rd Buffalo Grove IL 60089 Ph: (847) 229-1700 | Jacob S Lake Dds Ltd 15 E Dundee Rd Buffalo Grove IL 60089-4383 Ph: (847) 229-1700 |
| NPI Number | 1134389208 |
|---|---|
| Provider Enumeration Date | 06/12/2008 |
| Last Update Date | 12/30/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134389208 | NPI | - | NPPES |
| 197950 | Medicaid | IL | |
| 105621 | Medicaid | IL | |
| 104857 | Medicaid | IL | |
| 109096 | Medicaid | IL | |
| 105622 | Medicaid | IL | |
| 105875 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019016208 (Illinois) | Primary |
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