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General NPI Number Information
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NPI Number | 1093916231
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Entity Type | Individual
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Provider Name | JOHN PANZICA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 1535 LAKE COOK RD STE 104
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City | NORTHBROOK
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State | IL
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Zip | 60062-1450
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Country | US
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Telephone | 847-498-9767
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Fax | 847-498-9045
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Provider Business Mailing Address
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Address Line | 55 E WASHINGTON ST SUITE 2610
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City | CHICAGO
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State | IL
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Zip | 60602-2103
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Country | US
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Telephone | 312-853-3431
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Fax | 312-853-3432
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.017250
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.017250
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License Number State | IL
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