Provider Demographics
NPI:1194891085
Name:MARIA FAKLARIS D.D.S.,P.C.
Entity type:Organization
Organization Name:MARIA FAKLARIS D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKLARIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-622-1095
Mailing Address - Street 1:319 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2248
Mailing Address - Country:US
Mailing Address - Phone:847-622-1095
Mailing Address - Fax:847-622-1097
Practice Address - Street 1:319 RANDALL RD
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-2248
Practice Address - Country:US
Practice Address - Phone:847-622-1095
Practice Address - Fax:847-622-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190201731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty