Healthcare Provider Details

I. General information

NPI: 1598334773
Provider Name (Legal Business Name): MATTHEW A TOKARSKI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8854 OXFORD ST
WOODRIDGE IL
60517-4969
US

IV. Provider business mailing address

8854 OXFORD ST
WOODRIDGE IL
60517-4969
US

V. Phone/Fax

Practice location:
  • Phone: 630-512-1520
  • Fax:
Mailing address:
  • Phone: 630-512-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.033209
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: