Healthcare Provider Details

I. General information

NPI: 1205636214
Provider Name (Legal Business Name): CASSIOPEIA SUZUKI-WARD DDS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13247 S BALTIMORE AVE
CHICAGO IL
60633-1431
US

IV. Provider business mailing address

13247 S BALTIMORE AVE
CHICAGO IL
60633-1431
US

V. Phone/Fax

Practice location:
  • Phone: 773-309-4652
  • Fax:
Mailing address:
  • Phone: 303-436-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019037053
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: