MEDICARE: CHRISTOPHER R SZYDELKO 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	261QD0000X	Dental Clinic/Center	019027028	IL

General Provider Information

NPI Number	:	1821409301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOPHER R SZYDELKO DDS PC

Provider Business Mailing Address
First Line	:	5140 CUMNOR RD
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-5255
Country	:	US
Telephone Number	:	630-272-9592
Fax Number	:	630-541-6622

Provider Business Practice Location Address
First Line	:	5140 CUMNOR RD
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-5255
Country	:	US
Telephone Number	:	630-272-9592
Fax Number	:	630-541-6622

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER ROBERT SZYDELKO
Credential	:	DDS
Telephone Number	:	630-272-9592

Provider Enumeration Date	:	05/18/2014
Last Update Date	:	05/18/2014

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