Provider Demographics
NPI:1891225835
Name:PAWLOWSKI, PATRICK WESLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WESLEY
Last Name:PAWLOWSKI
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 1:2S570 THADDEUS CIR
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-7193
Mailing Address - Country:US
Mailing Address - Phone:630-235-8447
Mailing Address - Fax:
Practice Address - Street 1:303 E. 3RD STREET
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-5560
Practice Address - Country:US
Practice Address - Phone:630-235-8447
Practice Address - Fax:630-235-8447
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice