MEDICARE: DR. KENNETH JOHN SZAFRANSKI 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
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1316018500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH JOHN SZAFRANSKI DDS

Provider Business Mailing Address
First Line	:	5600 WOLF RD
Second Line	:	SUITE 130
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-2254
Country	:	US
Telephone Number	:	708-246-4333
Fax Number	:	708-246-4356

Provider Business Practice Location Address
First Line	:	5600 WOLF RD
Second Line	:	SUITE 130
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-2254
Country	:	US
Telephone Number	:	708-246-4333
Fax Number	:	708-246-4356

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

Provider Enumeration Date	:	11/11/2006
Last Update Date	:	10/23/2007

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