Provider Demographics
NPI:1770559395
Name:MARKS, ALLEN DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:DAVID
Last Name:MARKS
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 1:3116 MARY KAY LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1139
Mailing Address - Country:US
Mailing Address - Phone:847-564-2208
Mailing Address - Fax:
Practice Address - Street 1:64 OLD ORCHARD CTR
Practice Address - Street 2:SUITE 600
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1425
Practice Address - Country:US
Practice Address - Phone:847-676-9800
Practice Address - Fax:847-676-9801
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-127471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics