Provider Demographics
NPI:1649863309
Name:GRZEGOREK, DONNA MARIE (BS, RDH, PHDH)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:GRZEGOREK
Suffix:
Gender:F
Credentials:BS, RDH, PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PEBBLE BEACH CT
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-4493
Mailing Address - Country:US
Mailing Address - Phone:847-338-3235
Mailing Address - Fax:
Practice Address - Street 1:7 PEBBLE BEACH CT
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-4493
Practice Address - Country:US
Practice Address - Phone:847-338-3235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020-004194124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist