Provider Demographics
NPI:1952448474
Name:PAWLUSIEWICZ, KATHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:PAWLUSIEWICZ
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 1:259 E RAND RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2184
Mailing Address - Country:US
Mailing Address - Phone:847-890-4444
Mailing Address - Fax:847-506-0148
Practice Address - Street 1:259 E RAND RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2184
Practice Address - Country:US
Practice Address - Phone:847-890-4444
Practice Address - Fax:847-506-0148
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice