Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019021144 | IL |
N | 204E00000X | Oral & Maxillofacial Surgeon | 019021144 | IL |
N | 207PE0004X | Emergency Medical Services | 019021144 | IL |
NPI | 1508139635 |
---|---|
Provider Name | Dr. James B Lago |
First Address | Park Ridge, IL 60068-5014 |
Second Address | Park Ridge, IL 60068-5014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2012 |
Last Update Date | 21/02/2012 |