Healthcare Provider Details

I. General information

NPI: 1679597504
Provider Name (Legal Business Name): DAVID JOSEPH SEFCIK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 129TH INFANTRY DR SUITE 100
JOLIET IL
60435-3171
US

IV. Provider business mailing address

2801 CATON FARM RD
JOLIET IL
60435-1205
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-1605
  • Fax:
Mailing address:
  • Phone: 815-254-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: