Provider Demographics
NPI:1811076722
Name:JAROSIK, BETH ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:JAROSIK
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 1:6721 PINE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4935
Mailing Address - Country:US
Mailing Address - Phone:708-429-4126
Mailing Address - Fax:
Practice Address - Street 1:2630 FLOSSMOOR RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1546
Practice Address - Country:US
Practice Address - Phone:708-798-0990
Practice Address - Fax:708-798-3370
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-024291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist