1215063581 NPI number — DR. MARSHALL M DOLNICK DDS

Table of content: DR. MARSHALL M DOLNICK DDS (NPI 1215063581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215063581 NPI number — DR. MARSHALL M DOLNICK DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOLNICK
Provider First Name:
MARSHALL
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215063581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 DEERFIELD RD.
Provider Second Line Business Mailing Address:
# 301
Provider Business Mailing Address City Name:
HIGHLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60035-3504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-681-9250
Provider Business Mailing Address Fax Number:
773-588-3894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 DEERFIELD RD.
Provider Second Line Business Practice Location Address:
#301
Provider Business Practice Location Address City Name:
HIGHLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60035-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-588-3880
Provider Business Practice Location Address Fax Number:
773-588-3894
Provider Enumeration Date:
02/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  019011885 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 019-0-11885 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)