Provider Demographics
NPI:1578769204
Name:POGORZELSKI, ROGER J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:J
Last Name:POGORZELSKI
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 1:6759 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4418
Mailing Address - Country:US
Mailing Address - Phone:847-647-2202
Mailing Address - Fax:847-647-7560
Practice Address - Street 1:6759 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4418
Practice Address - Country:US
Practice Address - Phone:847-647-2202
Practice Address - Fax:847-647-7560
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190198021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice