Provider Demographics
NPI:1083816623
Name:SYDLOWSKI, SHAWN EDWARD (DR)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:EDWARD
Last Name:SYDLOWSKI
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 PONTIAC ST
Mailing Address - Street 2:PO BOX 337
Mailing Address - City:TONICA
Mailing Address - State:IL
Mailing Address - Zip Code:61370
Mailing Address - Country:US
Mailing Address - Phone:815-442-3588
Mailing Address - Fax:
Practice Address - Street 1:210 LASALLE ST
Practice Address - Street 2:
Practice Address - City:TONICA
Practice Address - State:IL
Practice Address - Zip Code:61370
Practice Address - Country:US
Practice Address - Phone:815-442-3550
Practice Address - Fax:815-442-3557
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice