Provider Demographics
NPI:1962536508
Name:LEON J WITKOWSKI JR DDS LTD
Entity type:Organization
Organization Name:LEON J WITKOWSKI JR DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRACTIONER DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:J
Authorized Official - Last Name:WITKOWSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS DENTSIT
Authorized Official - Phone:708-479-9888
Mailing Address - Street 1:19665 S LA GRANGE ROAD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448
Mailing Address - Country:US
Mailing Address - Phone:708-479-9888
Mailing Address - Fax:708-479-8900
Practice Address - Street 1:19665 S LA GRANGE ROAD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448
Practice Address - Country:US
Practice Address - Phone:708-479-9888
Practice Address - Fax:708-479-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty