Healthcare Provider Details

I. General information

NPI: 1225385701
Provider Name (Legal Business Name): KATHRYN ELIZABETH WOJCICKI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TIFFANY PT SUITE 209
BLOOMINGDALE IL
60108-2936
US

IV. Provider business mailing address

1 TIFFANY PT SUITE 209
BLOOMINGDALE IL
60108-2936
US

V. Phone/Fax

Practice location:
  • Phone: 630-671-0700
  • Fax:
Mailing address:
  • Phone: 630-671-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019029179
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: