MEDICARE: DR. MAGGIE W AUGUSTYN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19-026397	IL

General Provider Information

NPI Number	:	1073515193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAGGIE W AUGUSTYN DDS

Provider Business Mailing Address
First Line	:	2244 S ELIZABETH ST
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-7124
Country	:	US
Telephone Number	:	630-361-4178
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 MACOM DR
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-9349
Country	:	US
Telephone Number	:	630-585-5005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/18/2008

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