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General NPI Number Information
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NPI Number | 1699101477
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Entity Type | Organization
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Legal Business Name | KACZYNSKI DDS, P.C.
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 6075 N NORTHWEST HWY
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City | CHICAGO
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State | IL
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Zip | 60631-2502
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Country | US
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Telephone | 773-792-8008
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Fax |
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Provider Business Mailing Address
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Address Line | 603 PAULINE AVE
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1852
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Country | US
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Telephone | 224-210-0634
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS KACZYNSKI
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Credential |
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Telephone | 224-210-0634
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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 | 019029515
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License Number State | IL
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