Provider Demographics
NPI:1790972677
Name:JOANNA KOLANOWSKA, D.D.S.,LTD.
Entity Type:Organization
Organization Name:JOANNA KOLANOWSKA, D.D.S.,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:ZDZISLAWA
Authorized Official - Last Name:KOLANOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-223-8901
Mailing Address - Street 1:1148 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7960
Mailing Address - Country:US
Mailing Address - Phone:847-223-8901
Mailing Address - Fax:847-223-8968
Practice Address - Street 1:1148 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7960
Practice Address - Country:US
Practice Address - Phone:847-223-8901
Practice Address - Fax:847-223-8968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental