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General NPI Number Information
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NPI Number | 1730400623
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Entity Type | Individual
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Provider Name | MICHAEL S DUDA DDS
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Gender | Male
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 534 GREEN BAY RD
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City | KENILWORTH
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State | IL
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Zip | 60043-1801
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Country | US
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Telephone | 847-251-5136
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Fax |
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Provider Business Mailing Address
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Address Line | 2035 W DICKENS AVE
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City | CHICAGO
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State | IL
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Zip | 60647-4530
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Country | US
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Telephone | 847-571-0766
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Fax |
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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 | 019028318
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License Number State | IL
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