Provider Demographics
NPI:1467669911
Name:KOSIEK, RENATA (DDS)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:KOSIEK
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 1:3242 N NAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3901
Mailing Address - Country:US
Mailing Address - Phone:773-202-9178
Mailing Address - Fax:
Practice Address - Street 1:6825 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3702
Practice Address - Country:US
Practice Address - Phone:773-736-6610
Practice Address - Fax:773-736-6614
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190265921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice