Organization
FTDC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH KADZIELA (DENTIST)
(312) 949-9000
Entity
Organization
Contact information
Practice address
2413 S STATE ST, CHICAGO, IL 60616-2311
(312) 949-9000
Mailing address
2413 S STATE ST, CHICAGO, IL 60616-2311
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019020204
—
IL
Enumeration date
07/23/2017
Last updated
07/23/2017
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