Provider Demographics
NPI:1851467864
Name:MARK A WOJCIECHOWSKI DDS PC
Entity Type:Organization
Organization Name:MARK A WOJCIECHOWSKI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOJCIECHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-362-5511
Mailing Address - Street 1:800 S MILWAUKEE AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3268
Mailing Address - Country:US
Mailing Address - Phone:847-362-5511
Mailing Address - Fax:847-362-5198
Practice Address - Street 1:800 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3268
Practice Address - Country:US
Practice Address - Phone:847-362-5511
Practice Address - Fax:847-362-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty