Provider Demographics
NPI:1528378924
Name:DARGENE, MARK J (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:DARGENE
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 1:5001 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-5808
Mailing Address - Country:US
Mailing Address - Phone:815-639-6281
Mailing Address - Fax:
Practice Address - Street 1:5001 N 2ND ST
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-5808
Practice Address - Country:US
Practice Address - Phone:815-639-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0166621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice