Provider Demographics
NPI:1427122381
Name:DUBRAVEC, DOMINIK B (DDS, MMSC)
Entity type:Individual
Prefix:DR
First Name:DOMINIK
Middle Name:B
Last Name:DUBRAVEC
Suffix:
Gender:M
Credentials:DDS, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W COURT ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3664
Mailing Address - Country:US
Mailing Address - Phone:815-932-0554
Mailing Address - Fax:815-932-0976
Practice Address - Street 1:555 W COURT ST
Practice Address - Street 2:SUITE 202
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3664
Practice Address - Country:US
Practice Address - Phone:815-932-0554
Practice Address - Fax:815-932-0976
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics