Shawn Edward Sydlowski, DR
Individual provider Active NPI General Practice Dentistry · Tonica, IL
NPI 1083816623 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1083816623
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Practice address
- 210 Lasalle St
Tonica, IL 61370 - Phone
- (815) 442-3550
- Fax
- (815) 442-3557
- NPI assigned
- Jun 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.025598 | IL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IL | Yes |
Addresses
Primary practice location
210 Lasalle St
Tonica, IL 61370
Mailing address
511 Pontiac St
PO Box 337
Tonica, IL 61370
Phone (815) 442-3588
Other providers in Tonica, IL
All providers in Tonica, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.