Provider Demographics
NPI:1891309399
Name:DOMINIK DUBRAVEC DDS MMSC PC
Entity Type:Organization
Organization Name:DOMINIK DUBRAVEC DDS MMSC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIK
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBRAVEC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MMSC, PC
Authorized Official - Phone:815-932-0554
Mailing Address - Street 1:555 W COURT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3674
Mailing Address - Country:US
Mailing Address - Phone:815-932-0554
Mailing Address - Fax:815-932-0976
Practice Address - Street 1:555 W COURT ST STE 202
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3674
Practice Address - Country:US
Practice Address - Phone:815-932-0554
Practice Address - Fax:815-932-0976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty