Provider Demographics
NPI:1427502350
Name:MARJAN, LOOLUL (DMD)
Entity type:Individual
Prefix:DR
First Name:LOOLUL
Middle Name:
Last Name:MARJAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LOOLUL
Other - Middle Name:
Other - Last Name:MARJAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:2341 CRYDON PL
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5983
Mailing Address - Country:US
Mailing Address - Phone:734-834-9853
Mailing Address - Fax:
Practice Address - Street 1:2821 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2372
Practice Address - Country:US
Practice Address - Phone:847-662-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist