MEDICARE: KRZYSZTOF AUGUSTYN DENTAL CARE

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	019-024850	IL

General Provider Information

NPI Number	:	1508907544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRZYSZTOF AUGUSTYN DENTAL CARE

Provider Business Mailing Address
First Line	:	6033 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-5116
Country	:	US
Telephone Number	:	773-237-9373
Fax Number	:	773-237-9398

Provider Business Practice Location Address
First Line	:	6033 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-5116
Country	:	US
Telephone Number	:	773-237-9373
Fax Number	:	773-237-9398

Authorized Official
Title or Position	:	DDS
Name	:	DR. KRZYSZTOF AUGUSTYN
Credential	:
Telephone Number	:	773-237-9373

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	03/10/2014

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