Provider Demographics
NPI:1922211507
Name:IWASZCZYSZYN, IWONA STEFANIA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:IWONA
Middle Name:STEFANIA
Last Name:IWASZCZYSZYN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 7TH AVE
Mailing Address - Street 2:APT 6
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2903
Mailing Address - Country:US
Mailing Address - Phone:708-352-2287
Mailing Address - Fax:
Practice Address - Street 1:259 E RAND RD
Practice Address - Street 2:# 110
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2184
Practice Address - Country:US
Practice Address - Phone:847-890-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist