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General NPI Number Information
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NPI Number | 1861989287
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Entity Type | Organization
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Legal Business Name | RICHARD J PASIEWICZ DDS LLC
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Dates
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Enumeration Date | 04/20/2018
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 7600 W COLLEGE DR STE 17
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1066
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Country | US
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Telephone | 708-361-1770
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Fax |
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Provider Business Mailing Address
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Address Line | 1413 N LEAVITT ST
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City | CHICAGO
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State | IL
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Zip | 60622-1816
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Country | US
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Telephone | 847-721-9945
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD J PASIEWICZ
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Credential | DDS
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Telephone | 847-721-9945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 021.002593
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License Number State | IL
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