Provider Demographics
NPI:1730400623
Name:DUDA, MICHAEL S (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:DUDA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 W DICKENS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4530
Mailing Address - Country:US
Mailing Address - Phone:847-571-0766
Mailing Address - Fax:
Practice Address - Street 1:534 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:IL
Practice Address - Zip Code:60043-1801
Practice Address - Country:US
Practice Address - Phone:847-251-5136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist