Provider Demographics
NPI:1780069740
Name:GRYGLAK, MAGDALENA MARIANNA (DMD)
Entity type:Individual
Prefix:DR
First Name:MAGDALENA
Middle Name:MARIANNA
Last Name:GRYGLAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9812 SAYRE AVE 3D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415
Mailing Address - Country:US
Mailing Address - Phone:773-727-4356
Mailing Address - Fax:
Practice Address - Street 1:4712 MAIN ST
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1749
Practice Address - Country:US
Practice Address - Phone:630-964-0944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0302571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice