Provider Demographics
NPI:1184091274
Name:KOZAR-WARCHALOWSKA, BEATA (DDS)
Entity type:Individual
Prefix:
First Name:BEATA
Middle Name:
Last Name:KOZAR-WARCHALOWSKA
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 1:640 W ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5703
Mailing Address - Country:US
Mailing Address - Phone:847-364-5305
Mailing Address - Fax:847-364-7701
Practice Address - Street 1:640 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5703
Practice Address - Country:US
Practice Address - Phone:847-364-5305
Practice Address - Fax:847-364-7701
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist