Provider Demographics
NPI:1598946881
Name:MARK J HUMENIK, DDS, PC
Entity Type:Organization
Organization Name:MARK J HUMENIK, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HUMENIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-272-5400
Mailing Address - Street 1:1220 MEADOW RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3698
Mailing Address - Country:US
Mailing Address - Phone:847-272-5400
Mailing Address - Fax:
Practice Address - Street 1:1220 MEADOW RD
Practice Address - Street 2:SUITE 306
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-3698
Practice Address - Country:US
Practice Address - Phone:847-272-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental