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General NPI Number Information
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NPI Number | 1245690098
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Entity Type | Organization
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Legal Business Name | GREENWOOD DENTAL CARE LLC
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 609 W GREENWOOD AVE
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City | WAUKEGAN
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State | IL
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Zip | 60087-5000
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Country | US
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Telephone | 847-244-9000
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Fax | 847-244-0009
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Provider Business Mailing Address
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Address Line | 609 W GREENWOOD AVE
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City | WAUKEGAN
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State | IL
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Zip | 60087-5000
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Country | US
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Telephone | 847-244-9000
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Fax | 847-244-0009
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. NIKOL KURZIAK
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Credential | DDS
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Telephone | 847-244-9000
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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 | 019024191
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License Number State | IL
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