MEDICARE: GARFIELD RIDGE DENTISTRY LTD

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	122300000X	Dentist	19013926	IL

General Provider Information

NPI Number	:	1154303733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARFIELD RIDGE DENTISTRY LTD

Provider Business Mailing Address
First Line	:	6508 WEST ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638
Country	:	US
Telephone Number	:	773-586-5522
Fax Number	:	773-586-5534

Provider Business Practice Location Address
First Line	:	6508 WEST ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638
Country	:	US
Telephone Number	:	773-586-5522
Fax Number	:	773-586-5534

Authorized Official
Title or Position	:	DDS PRESIDENT
Name	:	JAMES JOSEPH SWIATEK
Credential	:	DDS
Telephone Number	:	773-586-5522

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	08/22/2020

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