MEDICARE: DR. JOHN PANZICA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019.017250	IL
2	1223G0001X	General Practice Dentistry	019.017250	IL

General Provider Information

NPI Number	:	1093916231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PANZICA D.D.S.

Provider Business Mailing Address
First Line	:	55 E WASHINGTON ST
Second Line	:	SUITE 2610
City	:	CHICAGO
State	:	IL
Zip	:	60602-2103
Country	:	US
Telephone Number	:	312-853-3431
Fax Number	:	312-853-3432

Provider Business Practice Location Address
First Line	:	1535 LAKE COOK RD STE 104
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1450
Country	:	US
Telephone Number	:	847-498-9767
Fax Number	:	847-498-9045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	04/25/2022

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Directions to “ DR. JOHN PANZICA D.D.S.” Practice Location

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