Provider Demographics
NPI:1093948697
Name:GRZESKOWIAK, KRYSTYNA M (DDS)
Entity Type:Individual
Prefix:
First Name:KRYSTYNA
Middle Name:M
Last Name:GRZESKOWIAK
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 1:5370 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1250
Mailing Address - Country:US
Mailing Address - Phone:773-763-6119
Mailing Address - Fax:
Practice Address - Street 1:5370 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1250
Practice Address - Country:US
Practice Address - Phone:773-763-6119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190220761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice