Provider Demographics
NPI:1609376029
Name:STOJKOWSKI, ELZBIETA MARIA (DDS)
Entity Type:Individual
Prefix:
First Name:ELZBIETA
Middle Name:MARIA
Last Name:STOJKOWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CHIPPEWA PATHWAY
Mailing Address - Street 2:
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1611
Mailing Address - Country:US
Mailing Address - Phone:773-307-0208
Mailing Address - Fax:
Practice Address - Street 1:5613 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2740
Practice Address - Country:US
Practice Address - Phone:773-286-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0312581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty