Provider Demographics
NPI:1669486353
Name:MIJEWSKI, RONALD EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EUGENE
Last Name:MIJEWSKI
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 1:33 S ADDISON RD
Mailing Address - Street 2:103
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3868
Mailing Address - Country:US
Mailing Address - Phone:630-941-3316
Mailing Address - Fax:630-941-7020
Practice Address - Street 1:33 S ADDISON RD
Practice Address - Street 2:103
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3868
Practice Address - Country:US
Practice Address - Phone:630-941-3316
Practice Address - Fax:630-941-7020
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist