Individual
DR. MARIUSZ KAJETAN WRZOSEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.D.
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(617) 240-6890
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-3678
(708) 216-8966
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019026949
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
019026949
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
036138796
IL
208600000X
Surgery Physician
251775
MA
Other
Enumeration date
05/19/2006
Last updated
12/07/2023
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