Provider Demographics
NPI:1225198575
Name:DR PATRICIA RACZKA & ASSOCIATES, LTD
Entity Type:Organization
Organization Name:DR PATRICIA RACZKA & ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RACZKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-446-4330
Mailing Address - Street 1:446 CENTRAL AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:446 CENTRAL AVE
Practice Address - Street 2:STE 200
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3048
Practice Address - Country:US
Practice Address - Phone:847-446-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01902457571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty