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General NPI Number Information
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NPI Number | 1730384082
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Entity Type | Individual
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Provider Name | KATARZYNA DZIEDIECH LOPEZ DDS
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 1640 N WELLS ST UNIT 205
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City | CHICAGO
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State | IL
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Zip | 60614-6006
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Country | US
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Telephone | 312-787-2000
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Fax | 312-829-2581
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Provider Business Mailing Address
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Address Line | 1635 W CORTLAND ST SUITE #1
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City | CHICAGO
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State | IL
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Zip | 60622
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Country | US
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Telephone | 773-904-8400
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Fax | 773-904-7155
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019-022206
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License Number State | IL
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