Provider Demographics
NPI:1093851511
Name:JOHN G MARCHESE DDS LTD
Entity Type:Organization
Organization Name:JOHN G MARCHESE DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:MARCHESE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-964-7852
Mailing Address - Street 1:5133 WASHINGTON ST
Mailing Address - Street 2:SUITE # 10
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4796
Mailing Address - Country:US
Mailing Address - Phone:630-964-7852
Mailing Address - Fax:630-964-7802
Practice Address - Street 1:5133 WASHINGTON ST
Practice Address - Street 2:SUITE # 10
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4796
Practice Address - Country:US
Practice Address - Phone:630-964-7852
Practice Address - Fax:630-964-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty