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General NPI Number Information
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NPI Number | 1841581436
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Entity Type | Organization
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Legal Business Name | STEPHEN T JAGIELO DDS PC
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Dates
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Enumeration Date | 04/29/2011
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 4913 MAIN ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3612
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Country | US
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Telephone | 630-969-4441
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Fax | 630-969-4480
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Provider Business Mailing Address
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Address Line | 4913 MAIN ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3612
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Country | US
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Telephone | 630-969-4441
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Fax | 630-969-4480
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN T JAGIELO
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Credential | DDS
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Telephone | 630-969-4441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 021-001523
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License Number State | IL
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