Provider Demographics
NPI:1275265860
Name:WISNIEWSKA, PAULINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAULINA
Middle Name:
Last Name:WISNIEWSKA
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 1:7783 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-2420
Mailing Address - Country:US
Mailing Address - Phone:630-213-6649
Mailing Address - Fax:
Practice Address - Street 1:728 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2640
Practice Address - Country:US
Practice Address - Phone:847-865-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0338361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice