Provider Demographics
NPI:1548398811
Name:DZAKOVICH, JOHN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:DZAKOVICH
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 1:1608 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3908
Mailing Address - Country:US
Mailing Address - Phone:847-255-4898
Mailing Address - Fax:847-255-4834
Practice Address - Street 1:1608 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3908
Practice Address - Country:US
Practice Address - Phone:847-255-4898
Practice Address - Fax:847-255-4834
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01900166951223G0001X
IL019-00166951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363193193OtherEMPLOYER ID NUMBER