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General NPI Number Information
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NPI Number | 1992126304
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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 | 01/02/2014
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 20635 ABBEY WOODS CT N SUITE 203
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City | FRANKFORT
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State | IL
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Zip | 60423-3181
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Country | US
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Telephone | 815-464-3001
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Fax | 815-464-3010
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Provider Business Mailing Address
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Address Line | 20635 ABBEY WOODS CT N SUITE 203
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City | FRANKFORT
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State | IL
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Zip | 60423-3181
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Country | US
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Telephone | 815-464-3001
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Fax | 815-464-3010
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOMINIK DUBRAVEC
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Credential | DDS MMSC
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Telephone | 815-464-3001
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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 | 019021633
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License Number State | IL
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