Provider Demographics
NPI:1962081273
Name:SZEWCZYK, GABRIELLA ANNE (DMD, PHD)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:ANNE
Last Name:SZEWCZYK
Suffix:
Gender:F
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:GABRIELLA
Other - Middle Name:ANNE
Other - Last Name:DEBRUYN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, PHD
Mailing Address - Street 1:836 W WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:836 W WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5147
Practice Address - Country:US
Practice Address - Phone:773-975-1600
Practice Address - Fax:773-296-5088
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program