Organization
EGDCLTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH KADZIELA (DENTIST)
(312) 885-0562
Entity
Organization
Contact information
Practice address
2451 W 79TH ST, CHICAGO, IL 60652-1734
(312) 885-0562
Mailing address
2451 W 79TH ST, CHICAGO, IL 60652-1734
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019020204
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019020204
—
IL
Enumeration date
01/26/2017
Last updated
01/26/2017
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