Healthcare Provider Details

I. General information

NPI: 1275709990
Provider Name (Legal Business Name): ELIZABETH PAJAK DDS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EASTGATE CT
ALGONQUIN IL
60102-3001
US

IV. Provider business mailing address

120 EASTGATE CT
ALGONQUIN IL
60102-3001
US

V. Phone/Fax

Practice location:
  • Phone: 847-458-4576
  • Fax:
Mailing address:
  • Phone: 847-458-4576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1005636
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name: DR. ELIZABETH PAJAK
Title or Position: DENTIST
Credential:
Phone: 847-458-4576