Provider Demographics
NPI:1639923865
Name:PATRICK R. MAGNER, DMD, P.C.
Entity Type:Organization
Organization Name:PATRICK R. MAGNER, DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-975-2820
Mailing Address - Street 1:6518 N TAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-2825
Mailing Address - Country:US
Mailing Address - Phone:847-975-2820
Mailing Address - Fax:
Practice Address - Street 1:1220 MEADOW RD STE 206
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-3671
Practice Address - Country:US
Practice Address - Phone:847-975-2820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty