Provider Demographics
NPI:1225144637
Name:DANIEL A DOHNALEK DDS LTD
Entity Type:Organization
Organization Name:DANIEL A DOHNALEK DDS LTD
Other - Org Name:MANUS DENTAL FOX LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOHNALEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-587-5053
Mailing Address - Street 1:1394 S US HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:FOX LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60020-1949
Mailing Address - Country:US
Mailing Address - Phone:847-587-5053
Mailing Address - Fax:
Practice Address - Street 1:1394 S US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1949
Practice Address - Country:US
Practice Address - Phone:847-587-5053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190186791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty