MEDICARE: ROMAN MARSZALEK D.D.S. HENRYKA MARSZALEK D.D.S.

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	019021941	IL

General Provider Information

NPI Number	:	1174835789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROMAN MARSZALEK D.D.S. HENRYKA MARSZALEK D.D.S.

Provider Business Mailing Address
First Line	:	5948 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3130
Country	:	US
Telephone Number	:	773-545-3789
Fax Number	:	773-545-1867

Provider Business Practice Location Address
First Line	:	5948 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3130
Country	:	US
Telephone Number	:	773-545-3789
Fax Number	:	773-545-1867

Authorized Official
Title or Position	:	CORPORATION PRESIDENT
Name	:	HENRYKA MARSZALEK
Credential	:
Telephone Number	:	773-545-3789

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	07/12/2010

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