Provider Demographics
NPI:1659627917
Name:MICHAEL SAMBORSKI DDS LTD
Entity Type:Organization
Organization Name:MICHAEL SAMBORSKI DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMBORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-636-5283
Mailing Address - Street 1:7901 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2115
Mailing Address - Country:US
Mailing Address - Phone:708-636-5283
Mailing Address - Fax:
Practice Address - Street 1:7901 LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2115
Practice Address - Country:US
Practice Address - Phone:708-636-5283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190177421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty