Provider Demographics
NPI:1912251372
Name:ENDODONTIC ASSOCIATES OF ILLINOIS, PC
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF ILLINOIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:PAWLUK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-729-4544
Mailing Address - Street 1:443 SUMMIT AVE
Mailing Address - Street 2:1S SUITE 306
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-729-4544
Mailing Address - Fax:630-756-0281
Practice Address - Street 1:443 SUMMIT AVE
Practice Address - Street 2:1S SUITE 306
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:630-729-4544
Practice Address - Fax:630-756-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210021181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty