Individual
MARK W LINGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
150 HARVESTER DR STE 300, BURR RIDGE, IL 60527-5965
(773) 834-4064
Mailing address
5841 S MARYLAND AVE # MC1099, CHICAGO, IL 60637-1447
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
019022138
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019022138
—
IL
Enumeration date
01/16/2007
Last updated
02/26/2019
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