Provider Demographics
NPI:1831101146
Name:PIOTROWSKI, TED JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:JOHN
Last Name:PIOTROWSKI
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 1:1855 DEERFIELD RD
Mailing Address - Street 2:STE G
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3750
Mailing Address - Country:US
Mailing Address - Phone:847-831-0700
Mailing Address - Fax:847-831-1973
Practice Address - Street 1:1855 DEERFIELD RD
Practice Address - Street 2:STE G
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3750
Practice Address - Country:US
Practice Address - Phone:847-831-0700
Practice Address - Fax:847-831-1973
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist