Healthcare Provider Details

I. General information

NPI: 1598863243
Provider Name (Legal Business Name): JAMES JOSEPH SWIATEK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6508 WEST ARCHER AVE
CHICAGO IL
60638
US

IV. Provider business mailing address

6508 WEST ARCHER AVE
CHICAGO IL
60638
US

V. Phone/Fax

Practice location:
  • Phone: 773-586-5522
  • Fax: 773-586-5534
Mailing address:
  • Phone: 773-586-5522
  • Fax: 773-586-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19013926
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: