Provider Demographics
NPI:1861919862
Name:WIERZBICKI, PATRYCJA MAJA (DMD)
Entity type:Individual
Prefix:DR
First Name:PATRYCJA
Middle Name:MAJA
Last Name:WIERZBICKI
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 1:76 LAKEVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1411
Mailing Address - Country:US
Mailing Address - Phone:773-732-7737
Mailing Address - Fax:
Practice Address - Street 1:890 N ROSELLE RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1850
Practice Address - Country:US
Practice Address - Phone:847-348-8969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-031354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist