Provider Demographics
NPI:1467026567
Name:MDP BLOOMINGDALE PC
Entity Type:Organization
Organization Name:MDP BLOOMINGDALE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:SZATKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-394-9040
Mailing Address - Street 1:76 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2201
Mailing Address - Country:US
Mailing Address - Phone:630-394-9040
Mailing Address - Fax:630-894-1148
Practice Address - Street 1:231 S GARY AVE STE 105
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2227
Practice Address - Country:US
Practice Address - Phone:630-351-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental