Provider Demographics
NPI:1265662423
Name:DEDEROWSKI, BEATA (DMD)
Entity Type:Individual
Prefix:DR
First Name:BEATA
Middle Name:
Last Name:DEDEROWSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11019 ASHTON LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8618
Mailing Address - Country:US
Mailing Address - Phone:708-691-4398
Mailing Address - Fax:
Practice Address - Street 1:14240 MCCARTHY RD
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-9393
Practice Address - Country:US
Practice Address - Phone:630-914-1500
Practice Address - Fax:630-914-1501
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist