Provider Demographics
NPI:1326206350
Name:SYDLEWSKI ORTHODONTICS
Entity Type:Organization
Organization Name:SYDLEWSKI ORTHODONTICS
Other - Org Name:SIGNATURE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SYDLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MD
Authorized Official - Phone:651-426-9986
Mailing Address - Street 1:2126 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-2717
Mailing Address - Country:US
Mailing Address - Phone:651-426-9986
Mailing Address - Fax:651-653-4653
Practice Address - Street 1:2126 5TH ST
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-2717
Practice Address - Country:US
Practice Address - Phone:651-426-9986
Practice Address - Fax:651-653-4653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10622261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental