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General NPI Number Information
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NPI Number | 1124507256
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Entity Type | Organization
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Legal Business Name | AGNIESZKA IWASZCZYSZYN DMD PC
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 728 W NORTHWEST HWY
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City | BARRINGTON
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State | IL
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Zip | 60010-2640
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Country | US
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Telephone | 847-865-4278
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Fax |
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Provider Business Mailing Address
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Address Line | 491 LESLIE CT APT 201
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City | DES PLAINES
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State | IL
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Zip | 60016-8817
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Country | US
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Telephone | 708-291-0354
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AGNIESZKA IWASZCZYSZYN
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Credential | DMD
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Telephone | 708-291-0354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019030692
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License Number State | IL
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