Provider Demographics
NPI:1245672542
Name:SZEREMETA-BROWAR, TAISA LYDIA (DDS)
Entity type:Individual
Prefix:DR
First Name:TAISA
Middle Name:LYDIA
Last Name:SZEREMETA-BROWAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TAISA
Other - Middle Name:L
Other - Last Name:BROWAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 4656
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-4656
Mailing Address - Country:US
Mailing Address - Phone:630-655-3737
Mailing Address - Fax:
Practice Address - Street 1:828 N CASS AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1394
Practice Address - Country:US
Practice Address - Phone:630-655-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-27
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017310122300000X
IL0210011411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist