Provider Demographics
NPI:1487863510
Name:CZECHURA, BEATA (DMD)
Entity Type:Individual
Prefix:
First Name:BEATA
Middle Name:
Last Name:CZECHURA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 ESSEX CT
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-2320
Mailing Address - Country:US
Mailing Address - Phone:773-502-9554
Mailing Address - Fax:
Practice Address - Street 1:504 N PLUM GROVE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8207
Practice Address - Country:US
Practice Address - Phone:847-359-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190271441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice