Provider Demographics
NPI:1326245945
Name:WEGRZYN, CAROL ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:WEGRZYN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:MAZANEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4811 W CRYSTAL LAKE RD
Mailing Address - Street 2:PO BOX 1690
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5412
Mailing Address - Country:US
Mailing Address - Phone:815-385-4411
Mailing Address - Fax:
Practice Address - Street 1:4811 W CRYSTAL LAKE RD
Practice Address - Street 2:PO 1690
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5412
Practice Address - Country:US
Practice Address - Phone:815-385-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist