Provider Demographics
NPI:1164520003
Name:STREITZ, MARK STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:STREITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 BLACK RD
Mailing Address - Street 2:EAST SUITE
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2902
Mailing Address - Country:US
Mailing Address - Phone:815-725-1919
Mailing Address - Fax:
Practice Address - Street 1:2751 BLACK RD
Practice Address - Street 2:EAST SUITE
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2902
Practice Address - Country:US
Practice Address - Phone:815-725-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist