Provider Demographics
NPI:1003049412
Name:BORZECKA, MARIA
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:BORZECKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3256 N PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4730
Mailing Address - Country:US
Mailing Address - Phone:773-481-1900
Mailing Address - Fax:773-481-7003
Practice Address - Street 1:3256 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4730
Practice Address - Country:US
Practice Address - Phone:773-481-1900
Practice Address - Fax:773-481-7003
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0280311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019.028031OtherLICENSE NUMBER