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General NPI Number Information
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NPI Number | 1679877195
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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 | 12/23/2010
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Last Update Date | 12/23/2010
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Provider Practice Location Address
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Address Line | 3 S GREENLEAF ST STE L
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City | GURNEE
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State | IL
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Zip | 60031-3377
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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 | 3 S. GREENLEAF ST STE L
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City | GURNEE
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State | IL
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Zip | 60031-3377
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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 | DR. TIMOTHY L 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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019018122
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License Number State | IL
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