Provider Demographics
NPI:1457482796
Name:WARYJAS, RONALD J (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:WARYJAS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRIGHTON PL
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5751
Mailing Address - Country:US
Mailing Address - Phone:630-841-1362
Mailing Address - Fax:
Practice Address - Street 1:401 E 162ND ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2236
Practice Address - Country:US
Practice Address - Phone:708-596-2226
Practice Address - Fax:708-596-2227
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics