MEDICARE: BEATA CZECHURA D.M.D., P.C.

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	19027144	IL

General Provider Information

NPI Number	:	1164694261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEATA CZECHURA D.M.D., P.C.

Provider Business Mailing Address
First Line	:	504 N PLUM GROVE RD STE A
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-8207
Country	:	US
Telephone Number	:	847-359-3336
Fax Number	:	847-359-3377

Provider Business Practice Location Address
First Line	:	504 N PLUM GROVE RD STE A
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-8207
Country	:	US
Telephone Number	:	847-359-3336
Fax Number	:	847-359-3377

Authorized Official
Title or Position	:	DOCTOR
Name	:	MS. BEATA A CZECHURA
Credential	:	D.M.D., P.C.
Telephone Number	:	847-359-3336

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	03/28/2008

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