Provider Demographics
NPI:1316018500
Name:SZAFRANSKI, KENNETH JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JOHN
Last Name:SZAFRANSKI
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 1:5600 WOLF RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-2254
Mailing Address - Country:US
Mailing Address - Phone:708-246-4333
Mailing Address - Fax:708-246-4356
Practice Address - Street 1:5600 WOLF RD
Practice Address - Street 2:SUITE 130
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-2254
Practice Address - Country:US
Practice Address - Phone:708-246-4333
Practice Address - Fax:708-246-4356
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice