Provider Demographics
NPI:1457562217
Name:GARWACKI, KIMBERLY ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:GARWACKI
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 1:1220 MEADOW RD
Mailing Address - Street 2:SUITE #206
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3698
Mailing Address - Country:US
Mailing Address - Phone:847-272-1588
Mailing Address - Fax:
Practice Address - Street 1:1220 MEADOW RD
Practice Address - Street 2:SUITE #206
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-3698
Practice Address - Country:US
Practice Address - Phone:847-272-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist