Provider Demographics
NPI:1235208307
Name:KURDZIEL CARON, LUCY TERESA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:TERESA
Last Name:KURDZIEL CARON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LUCY
Other - Middle Name:TERESA
Other - Last Name:KURDZIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:834 COURTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-698-6234
Mailing Address - Fax:
Practice Address - Street 1:4825 N MASON
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630
Practice Address - Country:US
Practice Address - Phone:773-545-4353
Practice Address - Fax:773-545-1282
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist