Provider Demographics
NPI:1275683575
Name:KAZANOWSKI, JOHN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:KAZANOWSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 MCHENRY RD
Mailing Address - Street 2:SUITE #201
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1373
Mailing Address - Country:US
Mailing Address - Phone:847-634-6575
Mailing Address - Fax:847-634-6578
Practice Address - Street 1:1161 MCHENRY RD
Practice Address - Street 2:SUITE #201
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1373
Practice Address - Country:US
Practice Address - Phone:847-634-6575
Practice Address - Fax:847-634-6578
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice