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General NPI Number Information
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NPI Number | 1962536508
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Entity Type | Organization
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Legal Business Name | LEON J WITKOWSKI JR DDS LTD
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 19665 S LA GRANGE ROAD
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City | MOKENA
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State | IL
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Zip | 60448
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Country | US
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Telephone | 708-479-9888
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Fax | 708-479-8900
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Provider Business Mailing Address
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Address Line | 19665 S LA GRANGE ROAD
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City | MOKENA
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State | IL
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Zip | 60448
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Country | US
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Telephone | 708-479-9888
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Fax | 708-479-8900
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Authorized Official
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Title or Position | OWNER PRACTIONER DDS
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Name | DR. LEON J WITKOWSKI JR.
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Credential | DDS DENTSIT
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Telephone | 708-479-9888
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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 |
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License Number State | IL
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