Provider Demographics
NPI:1669744587
Name:HENSELMAN, LESTER WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:LESTER
Middle Name:WILLIAM
Last Name:HENSELMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 SHERMER RD
Mailing Address - Street 2:200
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4579
Mailing Address - Country:US
Mailing Address - Phone:847-272-2181
Mailing Address - Fax:847-272-2390
Practice Address - Street 1:1310 SHERMER RD
Practice Address - Street 2:200
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4579
Practice Address - Country:US
Practice Address - Phone:847-272-2181
Practice Address - Fax:847-272-2390
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019014214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist