Provider Demographics
NPI:1457770893
Name:MARK A. LIGOCKI, DDS, PC.
Entity Type:Organization
Organization Name:MARK A. LIGOCKI, DDS, PC.
Other - Org Name:LIGOCKI DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIGOCKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-620-8099
Mailing Address - Street 1:1S224 SUMMIT AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3938
Mailing Address - Country:US
Mailing Address - Phone:630-620-8099
Mailing Address - Fax:630-620-8474
Practice Address - Street 1:1S224 SUMMIT AVE STE 104
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3938
Practice Address - Country:US
Practice Address - Phone:630-620-8099
Practice Address - Fax:630-620-8474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021841261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental