Provider Demographics
NPI:1023221264
Name:YUDKOWSKY, DAVID SAMUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SAMUEL
Last Name:YUDKOWSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9341 AVERS AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1312
Mailing Address - Country:US
Mailing Address - Phone:847-676-6512
Mailing Address - Fax:847-676-6502
Practice Address - Street 1:8800 BRONX AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1804
Practice Address - Country:US
Practice Address - Phone:847-676-6512
Practice Address - Fax:847-676-6502
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004289Medicaid
IL1004289Medicaid