Provider Demographics
NPI:1508907544
Name:KRZYSZTOF AUGUSTYN DENTAL CARE
Entity Type:Organization
Organization Name:KRZYSZTOF AUGUSTYN DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:KRZYSZTOF
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-237-9373
Mailing Address - Street 1:6033 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5116
Mailing Address - Country:US
Mailing Address - Phone:773-237-9373
Mailing Address - Fax:773-237-9398
Practice Address - Street 1:6033 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5116
Practice Address - Country:US
Practice Address - Phone:773-237-9373
Practice Address - Fax:773-237-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0248501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty