Provider Demographics
NPI:1457483547
Name:GWOZDZ, ALEKSANDRA M (DDS)
Entity Type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:M
Last Name:GWOZDZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 SUMMIT ST
Mailing Address - Street 2:#134
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120
Mailing Address - Country:US
Mailing Address - Phone:847-695-3368
Mailing Address - Fax:847-695-3351
Practice Address - Street 1:860 SUMMIT ST
Practice Address - Street 2:#134
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120
Practice Address - Country:US
Practice Address - Phone:847-695-3368
Practice Address - Fax:847-695-3351
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190266191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice