Provider Demographics
NPI:1710004510
Name:MICHAEL D. FEDYNA DDS, LTD.
Entity type:Organization
Organization Name:MICHAEL D. FEDYNA DDS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FEDYNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-382-0700
Mailing Address - Street 1:8 EXECUTIVE CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9531
Mailing Address - Country:US
Mailing Address - Phone:847-382-0700
Mailing Address - Fax:847-382-0707
Practice Address - Street 1:8 EXECUTIVE CT
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9531
Practice Address - Country:US
Practice Address - Phone:847-382-0700
Practice Address - Fax:847-382-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-25
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.020146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty