Healthcare Provider Details

I. General information

NPI: 1255480679
Provider Name (Legal Business Name): JOHN WILLIAM PAWLUK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1S443 SUMMIT AVE STE 306
OAKBROOK TERRACE IL
60181-3973
US

IV. Provider business mailing address

1S443 SUMMIT AVE STE 306
OAKBROOK TERRACE IL
60181-3973
US

V. Phone/Fax

Practice location:
  • Phone: 708-361-1770
  • Fax:
Mailing address:
  • Phone: 630-729-4544
  • Fax: 630-756-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019026513
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number21002118
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: