MEDICARE: DR. PAUL JOHN DENEMARK DDS, MSD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	019022926	IL

General Provider Information

NPI Number	:	1114163185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL JOHN DENEMARK DDS, MSD

Provider Business Mailing Address
First Line	:	3450 LACY ROAD
Second Line	:	SUITE 202B
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-4520
Country	:	US
Telephone Number	:	630-743-4967
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 LACY ROAD
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-4520
Country	:	US
Telephone Number	:	630-743-4967
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2008
Last Update Date	:	08/19/2016

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Directions to “ DR. PAUL JOHN DENEMARK DDS, MSD” Practice Location

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