Provider Demographics
NPI:1467770404
Name:KORKUS, JEFFERY JOHN III (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:JOHN
Last Name:KORKUS
Suffix:III
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 1:3650 N HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4025
Mailing Address - Country:US
Mailing Address - Phone:312-860-4001
Mailing Address - Fax:
Practice Address - Street 1:669 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5920
Practice Address - Country:US
Practice Address - Phone:312-291-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190282821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice