Provider Demographics
NPI:1285243675
Name:KARCZEWSKI, ALICIA MARIE (DDS)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:KARCZEWSKI
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 1:202 FOREST EDGE DR
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1980
Mailing Address - Country:US
Mailing Address - Phone:708-408-7134
Mailing Address - Fax:
Practice Address - Street 1:845 N MICHIGAN AVE STE 922E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2194
Practice Address - Country:US
Practice Address - Phone:708-408-7134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032812122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist