Provider Demographics
NPI:1851460042
Name:DANIELEWICZ, BRIAN PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PATRICK
Last Name:DANIELEWICZ
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 1:740 FLORSHEIM DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3712
Mailing Address - Country:US
Mailing Address - Phone:847-816-3377
Mailing Address - Fax:847-816-3858
Practice Address - Street 1:740 FLORSHEIM DR
Practice Address - Street 2:SUITE 12
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3712
Practice Address - Country:US
Practice Address - Phone:847-816-3377
Practice Address - Fax:847-816-3858
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0236641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice