Provider Demographics
NPI:1508110495
Name:MARCHWIAK, PRZEMYSLAW (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRZEMYSLAW
Middle Name:
Last Name:MARCHWIAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4127
Mailing Address - Country:US
Mailing Address - Phone:773-286-5333
Mailing Address - Fax:
Practice Address - Street 1:5419 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4127
Practice Address - Country:US
Practice Address - Phone:773-286-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190246321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice