Provider Demographics
NPI:1104965342
Name:SMYK-HORVATH, AGNIESZKA K (DDS)
Entity type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:K
Last Name:SMYK-HORVATH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 W CATALPA AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2282
Mailing Address - Country:US
Mailing Address - Phone:773-416-8504
Mailing Address - Fax:
Practice Address - Street 1:333 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2703
Practice Address - Country:US
Practice Address - Phone:312-738-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist