MEDICARE: DR. MARK F PLOSKONKA DDS

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	122300000X	Dentist	019021645	IL

General Provider Information

NPI Number	:	1508870999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK F PLOSKONKA DDS

Provider Business Mailing Address
First Line	:	1818 KELLY CT
Second Line	:
City	:	DARIEN
State	:	IL
Zip	:	60561-5600
Country	:	US
Telephone Number	:	630-810-1817
Fax Number	:

Provider Business Practice Location Address
First Line	:	7845 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-3100
Country	:	US
Telephone Number	:	773-846-6000
Fax Number	:

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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