Provider Demographics
NPI:1356917405
Name:MAZUREK, DAYNA (RDH, PHDH, CDHC)
Entity type:Individual
Prefix:
First Name:DAYNA
Middle Name:
Last Name:MAZUREK
Suffix:
Gender:F
Credentials:RDH, PHDH, CDHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16115 HURON ST
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0752
Mailing Address - Country:US
Mailing Address - Phone:708-595-2739
Mailing Address - Fax:
Practice Address - Street 1:16115 HURON ST
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0752
Practice Address - Country:US
Practice Address - Phone:708-595-2739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020015994124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist