Provider Demographics
NPI:1073663423
Name:SENECZKO, TAISA IRENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAISA
Middle Name:IRENE
Last Name:SENECZKO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1931
Mailing Address - Country:US
Mailing Address - Phone:847-255-5552
Mailing Address - Fax:847-255-5556
Practice Address - Street 1:314 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1931
Practice Address - Country:US
Practice Address - Phone:847-255-5552
Practice Address - Fax:847-255-5556
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0202521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice