MEDICARE: BEATA CZECHURA 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	1223G0001X	General Practice Dentistry	19027144	IL

General Provider Information

NPI Number	:	1487863510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATA CZECHURA D.M.D.

Provider Business Mailing Address
First Line	:	346 ESSEX CT
Second Line	:
City	:	WOOD DALE
State	:	IL
Zip	:	60191-2320
Country	:	US
Telephone Number	:	773-502-9554
Fax Number	:

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

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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