Organization
HERITAGE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH JAZDZEWSKI DDS (OFFICER OF CORPORATION)
(847) 395-1461
Entity
Organization
Contact information
Practice address
800 MAIN ST, ANTIOCH, IL 60002-1542
(847) 395-1461
(847) 395-9255
Mailing address
800 MAIN ST, ANTIOCH, IL 60002-1542
(847) 395-1461
(847) 395-9255
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/08/2007
Last updated
08/22/2020
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