=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194890400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARON SZESZYCKI DDS & MICHAEL A CERONE DDS LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 845 S MAIN SUITE 303
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-627-0899
-----------------------------------------------------
Fax | 630-627-0935
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 845 S MAIN SUITE 303
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-627-0899
-----------------------------------------------------
Fax | 630-627-0935
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. MICHAEL A CERONE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 630-627-0899
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------