Provider Demographics
NPI:1053487983
Name:MACZKO, MITCHELL ALLEN (DMD)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:ALLEN
Last Name:MACZKO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 E CENTRAL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HGTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:847-398-1334
Mailing Address - Fax:847-398-3096
Practice Address - Street 1:1112 E CENTRAL
Practice Address - Street 2:
Practice Address - City:ARLINGTON HGTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-398-1334
Practice Address - Fax:847-398-3096
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist