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General NPI Number Information
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NPI Number | 1891309399
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Entity Type | Organization
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Legal Business Name | DOMINIK DUBRAVEC DDS MMSC PC
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 555 W COURT ST STE 202
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City | KANKAKEE
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State | IL
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Zip | 60901-3674
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Country | US
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Telephone | 815-932-0554
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Fax | 815-932-0976
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Provider Business Mailing Address
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Address Line | 555 W COURT ST STE 202
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City | KANKAKEE
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State | IL
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Zip | 60901-3674
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Country | US
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Telephone | 815-932-0554
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Fax | 815-932-0976
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Authorized Official
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Title or Position | PERIODONTIST/OWNER
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Name | DR. DOMINIK DUBRAVEC
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Credential | DDS, MMSC, PC
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Telephone | 815-932-0554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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