MEDICARE: DR. ERICA ZOLNIERCZYK DMD

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	019028798	IL
2	1223G0001X	General Practice Dentistry	12011750A	IN
3	1223G0001X	General Practice Dentistry	019.028798	IL

General Provider Information

NPI Number	:	1932485356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA ZOLNIERCZYK DMD

Provider Business Mailing Address
First Line	:	14512 JOHN HUMPHREY DR
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-2902
Country	:	US
Telephone Number	:	708-460-6699
Fax Number	:	708-460-1481

Provider Business Practice Location Address
First Line	:	14512 JOHN HUMPHREY DR
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-2902
Country	:	US
Telephone Number	:	708-460-6699
Fax Number	:	708-460-1481

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

Provider Enumeration Date	:	10/31/2011
Last Update Date	:	11/11/2020

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