Provider Demographics
NPI:1013133289
Name:VIZGIRDA, MARGARET ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:ANNE
Last Name:VIZGIRDA
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 1:327 S BRAINARD AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2118
Mailing Address - Country:US
Mailing Address - Phone:708-579-9253
Mailing Address - Fax:
Practice Address - Street 1:6600 26TH ST
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2652
Practice Address - Country:US
Practice Address - Phone:708-788-6600
Practice Address - Fax:708-788-0432
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist