Provider Demographics
NPI:1477713774
Name:STANZAK & SCHULIEN
Entity Type:Organization
Organization Name:STANZAK & SCHULIEN
Other - Org Name:GREENBAY FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:STANCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-689-2900
Mailing Address - Street 1:2233 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3006
Mailing Address - Country:US
Mailing Address - Phone:847-689-2900
Mailing Address - Fax:847-689-9388
Practice Address - Street 1:2233 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3006
Practice Address - Country:US
Practice Address - Phone:847-689-2900
Practice Address - Fax:847-689-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019127981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty