Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | IL |
NPI | 1922176593 |
---|---|
Provider Name | Mrs. Sandra Lynn Pietrzak |
First Address | Woodridge, IL 60517 |
Second Address | Downers Grove, IL 60516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |