Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 019031871 | IL |
NPI | 1003399015 |
---|---|
Provider Name | Dr. Ashley Nozik |
First Address | Tinley Park, IL 60477-4300 |
Second Address | Tinley Park, IL 60477-4300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2018 |
Last Update Date | 16/10/2018 |