MEDICARE: DENNIS J DWYER DDS PC

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	19A15119	IL

General Provider Information

NPI Number	:	1326153636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENNIS J DWYER DDS PC

Provider Business Mailing Address
First Line	:	4621 W 103RD ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-4718
Country	:	US
Telephone Number	:	708-229-0606
Fax Number	:

Provider Business Practice Location Address
First Line	:	4621 W 103RD ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-4718
Country	:	US
Telephone Number	:	708-229-0606
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DENNIS JOHN DWYER
Credential	:	DDS
Telephone Number	:	708-229-0606

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	08/22/2020

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