Healthcare Provider Details

I. General information

NPI: 1588983753
Provider Name (Legal Business Name): PAULA SKOWRONSKI ADAMIAK D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 W DUNDEE RD
WHEELING IL
60090-3227
US

IV. Provider business mailing address

6217 N KIRKWOOD AVE
CHICAGO IL
60646-5025
US

V. Phone/Fax

Practice location:
  • Phone: 847-520-7484
  • Fax:
Mailing address:
  • Phone: 312-296-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019028265
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: