Provider Demographics
NPI:1518207893
Name:RONALDO MACAM,DMD,PC
Entity Type:Organization
Organization Name:RONALDO MACAM,DMD,PC
Other - Org Name:ALLSMILES FAMILY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALDO
Authorized Official - Middle Name:MONTEMAYOR
Authorized Official - Last Name:MACAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-298-9676
Mailing Address - Street 1:8872 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1752
Mailing Address - Country:US
Mailing Address - Phone:847-298-9676
Mailing Address - Fax:
Practice Address - Street 1:8872 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1752
Practice Address - Country:US
Practice Address - Phone:847-298-9676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-023795261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1144431453OtherTYPE 1 NPI