Provider Demographics
NPI:1497955942
Name:FLAK, MATTHEW DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DOUGLAS
Last Name:FLAK
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 1:2551 N CLARK STE 501
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1958
Mailing Address - Country:US
Mailing Address - Phone:312-498-3262
Mailing Address - Fax:
Practice Address - Street 1:2551 N CLARK ST STE 501
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7722
Practice Address - Country:US
Practice Address - Phone:312-498-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist