Provider Demographics
NPI:1316444219
Name:JOHN M KOROLEWSKI DDS LLC
Entity type:Organization
Organization Name:JOHN M KOROLEWSKI DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-458-8389
Mailing Address - Street 1:1407 N 8TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3400
Mailing Address - Country:US
Mailing Address - Phone:920-458-8389
Mailing Address - Fax:
Practice Address - Street 1:1407 N 8TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3400
Practice Address - Country:US
Practice Address - Phone:920-458-8389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment