Provider Demographics
NPI:1568534865
Name:APPLE DENTAL CENTER P.C.
Entity Type:Organization
Organization Name:APPLE DENTAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:PLOSKONKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-846-6000
Mailing Address - Street 1:7845 S COTTAGE GROVE AVE
Mailing Address - Street 2:SUITE #105
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-3100
Mailing Address - Country:US
Mailing Address - Phone:773-846-6000
Mailing Address - Fax:
Practice Address - Street 1:7845 S COTTAGE GROVE AVE
Practice Address - Street 2:SUITE #105
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-3100
Practice Address - Country:US
Practice Address - Phone:773-846-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0600064491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty