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General NPI Number Information
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NPI Number | 1568534865
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Entity Type | Organization
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Legal Business Name | APPLE DENTAL CENTER P.C.
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 7845 S COTTAGE GROVE AVE SUITE #105
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City | CHICAGO
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State | IL
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Zip | 60619-3100
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Country | US
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Telephone | 773-846-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 7845 S COTTAGE GROVE AVE SUITE #105
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City | CHICAGO
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State | IL
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Zip | 60619-3100
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Country | US
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Telephone | 773-846-6000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK FRANCIS PLOSKONKA
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Credential | DDS
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Telephone | 773-846-6000
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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 | 060006449
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License Number State | IL
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