Provider Demographics
NPI:1609369255
Name:POPKO, MACKENZIE RUE (DMD)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RUE
Last Name:POPKO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0N693 BEDFORD LN
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1078
Mailing Address - Country:US
Mailing Address - Phone:651-342-0567
Mailing Address - Fax:
Practice Address - Street 1:25158 W EAMES ST
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5404
Practice Address - Country:US
Practice Address - Phone:651-342-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0316281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice