Provider Demographics
NPI:1265922355
Name:KATHY PAWLUSIEWICZ DDS. DBA PROSPECT DENTAL
Entity type:Organization
Organization Name:KATHY PAWLUSIEWICZ DDS. DBA PROSPECT DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:IZABELA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWALSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-890-4444
Mailing Address - Street 1:1120 E. CENTRAL RD.
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:847-890-4444
Mailing Address - Fax:847-506-0148
Practice Address - Street 1:1120 E. CENTRAL RD.
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-890-4444
Practice Address - Fax:847-506-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190261581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty