Provider Demographics
NPI:1851380927
Name:MAREK, RICHARD R (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:MAREK
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 1:5929 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5419
Mailing Address - Country:US
Mailing Address - Phone:773-631-6887
Mailing Address - Fax:773-631-1898
Practice Address - Street 1:5929 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5419
Practice Address - Country:US
Practice Address - Phone:773-631-6887
Practice Address - Fax:773-631-1898
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19174701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL101834Medicaid