Provider Demographics
NPI:1497822290
Name:FRYSTAK, PHILIP (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:FRYSTAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7N082 MEDINAH RD # 310
Mailing Address - Street 2:
Mailing Address - City:MEDINAH
Mailing Address - State:IL
Mailing Address - Zip Code:60157-9620
Mailing Address - Country:US
Mailing Address - Phone:630-529-5813
Mailing Address - Fax:630-529-5882
Practice Address - Street 1:7N082 MEDINAH RD # 310
Practice Address - Street 2:
Practice Address - City:MEDINAH
Practice Address - State:IL
Practice Address - Zip Code:60157-9620
Practice Address - Country:US
Practice Address - Phone:630-529-5813
Practice Address - Fax:630-529-5882
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice