MEDICARE: DR. JOHN SANDRIK D.D.S.

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	:	1730224684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN SANDRIK D.D.S.

Provider Business Mailing Address
First Line	:	505 CHESTNUT LN
Second Line	:
City	:	DARIEN
State	:	IL
Zip	:	60561-3835
Country	:	US
Telephone Number	:	630-325-9206
Fax Number	:

Provider Business Practice Location Address
First Line	:	6234 S NARRAGANSETT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-4233
Country	:	US
Telephone Number	:	773-586-3456
Fax Number	:	773-586-1277

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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