Provider Demographics
NPI:1790853281
Name:COZZOLA, SHEILA CATHERINE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:CATHERINE
Last Name:COZZOLA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 VALLEYVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516
Mailing Address - Country:US
Mailing Address - Phone:630-434-8036
Mailing Address - Fax:
Practice Address - Street 1:2 E 22ND STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-627-4680
Practice Address - Fax:630-627-4690
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist