Provider Demographics
NPI:1164698858
Name:WIBICKI, NANCY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:G
Last Name:WIBICKI
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 1:4 CEDAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-4712
Mailing Address - Country:US
Mailing Address - Phone:847-458-4758
Mailing Address - Fax:847-458-4760
Practice Address - Street 1:4 CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-4712
Practice Address - Country:US
Practice Address - Phone:847-458-4758
Practice Address - Fax:847-458-4760
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist