Provider Demographics
NPI:1659426310
Name:PIEKOS, MARTIN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:PIEKOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8222 W OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2723
Mailing Address - Country:US
Mailing Address - Phone:847-823-6100
Mailing Address - Fax:847-823-8450
Practice Address - Street 1:8222 W OAKTON ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2723
Practice Address - Country:US
Practice Address - Phone:847-823-6100
Practice Address - Fax:847-823-8450
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice