Provider Demographics
NPI:1972678860
Name:FAKLARIS, MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:FAKLARIS
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 1:319 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2248
Mailing Address - Country:US
Mailing Address - Phone:847-622-1095
Mailing Address - Fax:847-622-1097
Practice Address - Street 1:319 RANDALL RD
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-2248
Practice Address - Country:US
Practice Address - Phone:847-622-1095
Practice Address - Fax:847-622-1097
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190201731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1205145364OtherORGANIZATION NPI
IL1194891085OtherORGANIZATION NPI