Kenneth Jazdzewski, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

800 Main St
Antioch, IL 60002-1542

Phone

(847) 395-1461

Fax

(847) 395-9255

NPI assigned

Jan 9, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215086509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 MAIN ST",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600021542",
            "telephone_number": "847-395-1461",
            "fax_number": "847-395-9255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MAIN ST",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600021542",
            "telephone_number": "847-395-1461",
            "fax_number": "847-395-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAZDZEWSKI",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Antioch, IL
• Providers in Antioch, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.