Provider Demographics
NPI:1801041421
Name:DAVID S. DUDA DDS PC
Entity Type:Organization
Organization Name:DAVID S. DUDA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE CORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:IZQUIERDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-251-5136
Mailing Address - Street 1:534 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60043-1801
Mailing Address - Country:US
Mailing Address - Phone:847-251-5136
Mailing Address - Fax:847-251-1365
Practice Address - Street 1:534 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:IL
Practice Address - Zip Code:60043-1801
Practice Address - Country:US
Practice Address - Phone:847-251-5136
Practice Address - Fax:847-251-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190179461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty