Provider Demographics
NPI:1417046905
Name:MARK R COMMEAN DMD LTD
Entity Type:Organization
Organization Name:MARK R COMMEAN DMD LTD
Other - Org Name:BOULDER HILL DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:COMMEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-896-5013
Mailing Address - Street 1:20 BOULDER HILL PASS
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-1951
Mailing Address - Country:US
Mailing Address - Phone:630-896-5013
Mailing Address - Fax:630-896-5108
Practice Address - Street 1:20 BOULDER HILL PASS
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-1951
Practice Address - Country:US
Practice Address - Phone:630-896-5013
Practice Address - Fax:630-896-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01914998122300000X
IL122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty