Provider Demographics
NPI:1699404475
Name:YAKONSKYY, MAKSYM (DMD)
Entity type:Individual
Prefix:
First Name:MAKSYM
Middle Name:
Last Name:YAKONSKYY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 BLACKTHORN RD
Mailing Address - Street 2:
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3774
Mailing Address - Country:US
Mailing Address - Phone:773-837-4524
Mailing Address - Fax:
Practice Address - Street 1:33 N DEARBORN ST STE 2400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3109
Practice Address - Country:US
Practice Address - Phone:177-388-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist