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General NPI Number Information
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NPI Number | 1437486446
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Entity Type | Organization
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Legal Business Name | AGNIESZKA OSIKA DMD, LTD
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Dates
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Enumeration Date | 11/11/2009
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | 6101 W DAKIN ST
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City | CHICAGO
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State | IL
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Zip | 60634-2537
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Country | US
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Telephone | 773-343-3811
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Fax |
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Provider Business Mailing Address
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Address Line | 6101 W DAKIN ST
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City | CHICAGO
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State | IL
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Zip | 60634-2537
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Country | US
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Telephone | 773-343-3811
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | AGNIESZKA OSIKA
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Credential | DMD
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Telephone | 773-343-3811
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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 | 019028023
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License Number State | IL
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