Provider Demographics
NPI:1689795957
Name:LAMARCA, MICHAEL ALLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLAN
Last Name:LAMARCA
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 1:642 S SUTTON RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-2368
Mailing Address - Country:US
Mailing Address - Phone:630-497-9787
Mailing Address - Fax:630-497-9387
Practice Address - Street 1:642 S SUTTON RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-2368
Practice Address - Country:US
Practice Address - Phone:630-497-9787
Practice Address - Fax:630-497-9387
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0263711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice