Healthcare Provider Details

I. General information

NPI: 1003739996
Provider Name (Legal Business Name): JOANA BAKU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 S IL ROUTE 83
MUNDELEIN IL
60060-4576
US

IV. Provider business mailing address

1525 LAKE COOK RD APT 237
DEERFIELD IL
60015-5297
US

V. Phone/Fax

Practice location:
  • Phone: 224-628-7147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037292
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: