Healthcare Provider Details

I. General information

NPI: 1558509497
Provider Name (Legal Business Name): MARK SEFCHECK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N WASHINGTON ST
NAPERVILLE IL
60540-4511
US

IV. Provider business mailing address

129 N WASHINGTON ST
NAPERVILLE IL
60540-4511
US

V. Phone/Fax

Practice location:
  • Phone: 630-961-1048
  • Fax:
Mailing address:
  • Phone: 630-961-1048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019015718
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: