Provider Demographics
NPI:1740430420
Name:PELAK, ANNA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:M
Last Name:PELAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 N 1ST BANK DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8111
Mailing Address - Country:US
Mailing Address - Phone:847-358-2477
Mailing Address - Fax:847-358-1217
Practice Address - Street 1:647 N 1ST BANK DR
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8111
Practice Address - Country:US
Practice Address - Phone:847-358-2477
Practice Address - Fax:847-358-1217
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01938549001223E0200X, 1223G0001X, 1223P0221X, 1223P0300X, 1223P0700X
IL01935849001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223E0200XDental ProvidersDentistEndodontics
No1223P0221XDental ProvidersDentistPediatric Dentistry
No1223P0300XDental ProvidersDentistPeriodontics
No1223P0700XDental ProvidersDentistProsthodontics
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery