Provider Demographics
NPI:1306992326
Name:UDITSKY, DANIEL N (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:N
Last Name:UDITSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E HIGGINS ROAD
Mailing Address - Street 2:SUITE 7 EAST
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4762
Mailing Address - Country:US
Mailing Address - Phone:847-882-8770
Mailing Address - Fax:847-882-5698
Practice Address - Street 1:650 E HIGGINS ROAD
Practice Address - Street 2:SUITE 7 EAST
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4762
Practice Address - Country:US
Practice Address - Phone:847-882-8770
Practice Address - Fax:847-882-5698
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A13G921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice