Healthcare Provider Details

I. General information

NPI: 1508870999
Provider Name (Legal Business Name): MARK F PLOSKONKA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7845 S COTTAGE GROVE AVE
CHICAGO IL
60619-3100
US

IV. Provider business mailing address

1818 KELLY CT
DARIEN IL
60561-5600
US

V. Phone/Fax

Practice location:
  • Phone: 773-846-6000
  • Fax:
Mailing address:
  • Phone: 630-810-1817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019021645
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: