=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881808236
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. SHARON SZESZYCKI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 09/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 845 S MAIN ST STE 303
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-3350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-627-0899
-----------------------------------------------------
Fax | 630-627-0935
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 S PARK BLVD STE 190
-----------------------------------------------------
City | GLEN ELLYN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60137-6282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-469-0800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 019018256
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------