MEDICARE: DR. BEATA DEDEROWSKI D.M.D.

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	019028040	IL

General Provider Information

NPI Number	:	1265662423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEATA DEDEROWSKI D.M.D.

Provider Business Mailing Address
First Line	:	11019 ASHTON LN
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-8618
Country	:	US
Telephone Number	:	708-691-4398
Fax Number	:

Provider Business Practice Location Address
First Line	:	14240 MCCARTHY RD
Second Line	:
City	:	LEMONT
State	:	IL
Zip	:	60439-9393
Country	:	US
Telephone Number	:	630-914-1500
Fax Number	:	630-914-1501

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

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	10/15/2021

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