Healthcare Provider Details

I. General information

NPI: 1548398811
Provider Name (Legal Business Name): JOHN J DZAKOVICH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 N ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60004-3908
US

IV. Provider business mailing address

1608 N ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60004-3908
US

V. Phone/Fax

Practice location:
  • Phone: 847-255-4898
  • Fax: 847-255-4834
Mailing address:
  • Phone: 847-255-4898
  • Fax: 847-255-4834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0190016695
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-0016695
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: