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General NPI Number Information
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NPI Number | 1245435239
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Entity Type | Organization
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Legal Business Name | ASSOCIATES FOR FAMILY DENTISTRY CHICAGO LTD
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 183 S BLOOMINGDALE RD SUITE 3
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1466
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Country | US
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Telephone | 630-893-8636
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Fax | 630-893-4962
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Provider Business Mailing Address
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Address Line | 183 S BLOOMINGDALE RD SUITE 3
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1466
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Country | US
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Telephone | 630-893-8636
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Fax | 630-893-4962
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Authorized Official
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Title or Position | PRESIDENT DENTIST
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Name | DR. THOMAS J WODNIAK
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Credential | D.D.S.
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Telephone | 630-893-8636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IL
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