Provider Demographics
NPI:1265418131
Name:BIALEK, RUTH ANN (DDS)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:BIALEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:BIALEK KOZIOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3001 A SIXTH STREET
Mailing Address - Street 2:NAVAL HOSPITAL GREAT LAKES
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-5211
Mailing Address - Country:US
Mailing Address - Phone:847-688-2100
Mailing Address - Fax:847-688-5995
Practice Address - Street 1:1300 SOMERSET DRIVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:847-998-6908
Practice Address - Fax:847-998-6908
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190175911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice