Provider Demographics
NPI:1992126304
Name:DOMINIK DUBRAVEC DDS MMSC PC
Entity type:Organization
Organization Name:DOMINIK DUBRAVEC DDS MMSC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIK
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBRAVEC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MMSC
Authorized Official - Phone:815-464-3001
Mailing Address - Street 1:20635 ABBEY WOODS CT N
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3181
Mailing Address - Country:US
Mailing Address - Phone:815-464-3001
Mailing Address - Fax:815-464-3010
Practice Address - Street 1:20635 ABBEY WOODS CT N
Practice Address - Street 2:SUITE 203
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3181
Practice Address - Country:US
Practice Address - Phone:815-464-3001
Practice Address - Fax:815-464-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190216331223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty