Provider Demographics
NPI:1609081926
Name:WOJCIECHOWSKI, MARK ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ADAM
Last Name:WOJCIECHOWSKI
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 1:800 S MILWAUKEE AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3254
Mailing Address - Country:US
Mailing Address - Phone:847-362-5511
Mailing Address - Fax:847-362-5198
Practice Address - Street 1:800 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3254
Practice Address - Country:US
Practice Address - Phone:847-362-5511
Practice Address - Fax:847-362-5198
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice