Provider Demographics
NPI:1689837585
Name:MAGGIO, FRANK A
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:A
Last Name:MAGGIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 LARKIN AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5880
Mailing Address - Country:US
Mailing Address - Phone:847-697-4646
Mailing Address - Fax:847-697-8364
Practice Address - Street 1:2000 LARKIN AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5880
Practice Address - Country:US
Practice Address - Phone:847-697-4646
Practice Address - Fax:847-697-8364
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL210008761223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics