Provider Demographics
NPI:1861561383
Name:KLAPPER, LEWIS (DMD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:
Last Name:KLAPPER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E SCRANTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2553
Mailing Address - Country:US
Mailing Address - Phone:847-735-1502
Mailing Address - Fax:
Practice Address - Street 1:110 E SCRANTON AVE
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2553
Practice Address - Country:US
Practice Address - Phone:847-735-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021-0009931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL353450Medicare PIN
IL51585Medicare UPIN