Provider Demographics
NPI:1669025920
Name:DUDAS-SZEWCZYK, KATHERINE (DMD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DUDAS-SZEWCZYK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2316 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2228
Practice Address - Country:US
Practice Address - Phone:312-491-0601
Practice Address - Fax:312-491-0602
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190321861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice