Provider Demographics
NPI:1679877195
Name:TIMOTHY L. STRAKA D.D.S., L.L.C.
Entity Type:Organization
Organization Name:TIMOTHY L. STRAKA D.D.S., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STRAKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-360-8450
Mailing Address - Street 1:3 S. GREENLEAF ST STE L
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3377
Mailing Address - Country:US
Mailing Address - Phone:847-360-8450
Mailing Address - Fax:
Practice Address - Street 1:3 S GREENLEAF ST STE L
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3377
Practice Address - Country:US
Practice Address - Phone:847-360-8450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190181221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty