Provider Demographics
NPI:1528274461
Name:MAYWOOD DENTAL EXCELLENCE
Entity type:Organization
Organization Name:MAYWOOD DENTAL EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:D. MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CVETKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-865-2225
Mailing Address - Street 1:1409 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-2128
Mailing Address - Country:US
Mailing Address - Phone:708-865-2225
Mailing Address - Fax:708-865-2282
Practice Address - Street 1:1409 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-2128
Practice Address - Country:US
Practice Address - Phone:708-865-2225
Practice Address - Fax:708-865-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental