Provider Demographics
NPI:1801125513
Name:MARIA BORZECKA, DDS, CORP
Entity type:Organization
Organization Name:MARIA BORZECKA, DDS, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORZECKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-501-7907
Mailing Address - Street 1:6010 W HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4230
Mailing Address - Country:US
Mailing Address - Phone:773-501-7907
Mailing Address - Fax:
Practice Address - Street 1:1029 HOWARD ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3877
Practice Address - Country:US
Practice Address - Phone:847-491-0660
Practice Address - Fax:847-869-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028031302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization