Provider Demographics
NPI:1659598704
Name:NYKAZA, DAN JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:JOSEPH
Last Name:NYKAZA
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 1:1818 WILMETTE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2429
Mailing Address - Country:US
Mailing Address - Phone:847-256-4939
Mailing Address - Fax:847-864-9593
Practice Address - Street 1:2200 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1416
Practice Address - Country:US
Practice Address - Phone:847-869-7710
Practice Address - Fax:847-864-9593
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19020241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist