Provider Demographics
NPI:1619093952
Name:HUMENIK, MARK JOSEPH (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:HUMENIK
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
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:847-272-0027
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:847-272-0027
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice