MEDICARE: KRYSTYNA M GRZESKOWIAK 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	19022076	IL

General Provider Information

NPI Number	:	1093948697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTYNA M GRZESKOWIAK DDS

Provider Business Mailing Address
First Line	:	5370 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1250
Country	:	US
Telephone Number	:	773-763-6119
Fax Number	:

Provider Business Practice Location Address
First Line	:	5370 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1250
Country	:	US
Telephone Number	:	773-763-6119
Fax Number	:

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

Provider Enumeration Date	:	08/29/2009
Last Update Date	:	08/29/2009

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