# FAMILY MILLENNIUM DENTISTRY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MILLENNIUM DENTAL GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790146132
- **Authorized official:** LAWRENCE H ZAGER D.D.S. PC (DENTIST / OWNER)
- **Authorized official phone:** (312) 767-0407

## Contact information

- **Practice address:** 1342 W RANDOLPH ST, CHICAGO, IL 60607-1522
- **Practice address phone:** (312) 767-0407
- **Practice address fax:** (312) 988-0292
- **Mailing address:** 1342 W RANDOLPH ST, CHICAGO, IL 60607-1522
- **Mailing address phone:** (312) 767-0407
- **Mailing address fax:** (312) 988-0292

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 021001094 | IL | Yes |

## Other

- **Enumeration date:** 03/13/2016
- **Last updated:** 04/08/2016