Provider Demographics
NPI:1326059759
Name:WYSHNYTZKY, ANDREW P (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:WYSHNYTZKY
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 1:2525 WAUKEGAN RD
Mailing Address - Street 2:SUITE 265
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5514
Mailing Address - Country:US
Mailing Address - Phone:847-948-5988
Mailing Address - Fax:
Practice Address - Street 1:2525 WAUKEGAN RD
Practice Address - Street 2:SUITE 265
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-5514
Practice Address - Country:US
Practice Address - Phone:847-948-5988
Practice Address - Fax:847-948-5997
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice