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General NPI Number Information
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NPI Number | 1205145364
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Entity Type | Organization
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Legal Business Name | DR. MARIA FAKLARIS, P.C.
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Dates
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Enumeration Date | 10/06/2010
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Last Update Date | 10/06/2010
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Provider Practice Location Address
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Address Line | 300 HIGGINS RD
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City | PARK RIDGE
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State | IL
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Zip | 60068-5745
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Country | US
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Telephone | 847-696-0746
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Fax | 847-696-9092
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Provider Business Mailing Address
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Address Line | 300 HIGGINS RD
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City | PARK RIDGE
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State | IL
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Zip | 60068-5745
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Country | US
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Telephone | 847-696-0746
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Fax | 847-696-9092
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIA FAKLARIS
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Credential | D.D.S.
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Telephone | 847-696-0746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019020173
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License Number State | IL
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