Provider Demographics
NPI:1700988946
Name:MEDICAL CENTER DENTAL ASSOC
Entity Type:Organization
Organization Name:MEDICAL CENTER DENTAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:CURCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-437-8366
Mailing Address - Street 1:901 BRESTERFIELD RD
Mailing Address - Street 2:STE 104
Mailing Address - City:ELK GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60007
Mailing Address - Country:US
Mailing Address - Phone:847-437-8366
Mailing Address - Fax:847-437-8386
Practice Address - Street 1:901 BRESTERFIELD RD
Practice Address - Street 2:STE 104
Practice Address - City:ELK GROVE
Practice Address - State:IL
Practice Address - Zip Code:60007
Practice Address - Country:US
Practice Address - Phone:847-437-8366
Practice Address - Fax:847-437-8386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0600041861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty