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General NPI Number Information
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NPI Number | 1205132925
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Entity Type | Organization
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Legal Business Name | TIMOTHY L. STRAKA D.D.S., L.L.C.
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 2409 W WARREN BLVD
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City | CHICAGO
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State | IL
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Zip | 60612-2115
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Country | US
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Telephone | 847-360-8450
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Fax |
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Provider Business Mailing Address
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Address Line | 2409 W WARREN BLVD
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City | CHICAGO
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State | IL
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Zip | 60612-2115
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Country | US
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Telephone | 847-360-8450
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. TIMOTHY LARS STRAKA
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Credential | D.D.S.
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Telephone | 847-360-8450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019018122
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License Number State | IL
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