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General NPI Number Information
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NPI Number | 1174835789
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Entity Type | Organization
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Legal Business Name | ROMAN MARSZALEK D.D.S. HENRYKA MARSZALEK D.D.S.
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 5948 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-3130
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Country | US
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Telephone | 773-545-3789
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Fax | 773-545-1867
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Provider Business Mailing Address
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Address Line | 5948 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-3130
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Country | US
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Telephone | 773-545-3789
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Fax | 773-545-1867
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Authorized Official
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Title or Position | CORPORATION PRESIDENT
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Name | HENRYKA MARSZALEK
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Credential |
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Telephone | 773-545-3789
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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 | 019021941
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License Number State | IL
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