Provider Demographics
NPI:1164577169
Name:KEDZIOR, MALGORZATA (DDS)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:
Last Name:KEDZIOR
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 1:6324 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-3700
Mailing Address - Country:US
Mailing Address - Phone:773-774-4411
Mailing Address - Fax:773-774-7770
Practice Address - Street 1:6324 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-3700
Practice Address - Country:US
Practice Address - Phone:773-774-4411
Practice Address - Fax:773-774-7770
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist