Heritage Dental

NPI #1356490700 in Antioch, Illinois

Provider Information

NPI Number: 1356490700
Entity Type: Organization
Organization Name: Heritage Dental
Primary Specialty: Dentist - General Practice
Enumeration Date: Jan 8, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 800 MAIN ST
City: Antioch
State: Illinois
ZIP Code: 60002-1542
Phone: (847) 395-1461

Authorized Official

Name: DR. KENNETH JAZDZEWSKI, DDS
Title: OFFICER OF CORPORATION
Phone: (847) 395-1461

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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