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NPI Code Detail

MEDICARE: DR. BOZENA A KRYZAK DDS

MEDICARE:  DR. BOZENA A KRYZAK  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
1122300000XDentist019021797IL

General Provider Information

NPI Number : 1114157278
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BOZENA A KRYZAK DDS
Provider Business Mailing Address
First Line : 4810 N CENTRAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-3212
Country : US
Telephone Number : 773-685-6560
Fax Number :
Provider Business Practice Location Address
First Line : 4810 N CENTRAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-3212
Country : US
Telephone Number : 773-685-6560
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2009
Last Update Date : 07/22/2009

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Directions to “ DR. BOZENA A KRYZAK DDS” Practice Location

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