Provider Demographics
NPI:1215063581
Name:DOLNICK, MARSHALL M (DDS)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:M
Last Name:DOLNICK
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 1:1000 DEERFIELD RD.
Mailing Address - Street 2:# 301
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3504
Mailing Address - Country:US
Mailing Address - Phone:847-681-9250
Mailing Address - Fax:773-588-3894
Practice Address - Street 1:1000 DEERFIELD RD.
Practice Address - Street 2:#301
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3504
Practice Address - Country:US
Practice Address - Phone:773-588-3880
Practice Address - Fax:773-588-3894
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190118851223G0001X
IL019-0-118851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice