Provider Demographics
NPI:1770946378
Name:PIENKOWSKA, MALGORZATA (DDS)
Entity type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:
Last Name:PIENKOWSKA
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 1:8107 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2803
Mailing Address - Country:US
Mailing Address - Phone:847-470-8822
Mailing Address - Fax:
Practice Address - Street 1:8107 N. MILWAUKEE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2803
Practice Address - Country:US
Practice Address - Phone:847-470-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190251831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice