Individual
LYDIA JAEL DEJONGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
6305 W 95TH ST STE 200, OAK LAWN, IL 60453-2795
(708) 424-1300
Mailing address
6305 W 95TH ST STE 200, OAK LAWN, IL 60453-2795
(708) 424-1300
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
019.032838
IL
1223P0221X
Pediatric Dentistry
021.003285
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/20/2020
Last updated
10/24/2023
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