Provider Demographics
NPI:1508932187
Name:PAVNICA & MAGGOS, P.C.
Entity Type:Organization
Organization Name:PAVNICA & MAGGOS, P.C.
Other - Org Name:PARK DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGGOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-510-7800
Mailing Address - Street 1:26W276 GENEVA RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2228
Mailing Address - Country:US
Mailing Address - Phone:630-510-7800
Mailing Address - Fax:630-510-1491
Practice Address - Street 1:26W276 GENEVA RD
Practice Address - Street 2:SUITE E
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2228
Practice Address - Country:US
Practice Address - Phone:630-510-7800
Practice Address - Fax:630-510-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty