Provider Demographics
NPI:1841309929
Name:FAJARDO, MARCO TULIO JR (DDS)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:TULIO
Last Name:FAJARDO
Suffix:JR
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 1:340 TUPELO AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7828
Mailing Address - Country:US
Mailing Address - Phone:630-327-9295
Mailing Address - Fax:
Practice Address - Street 1:380 W DIEHL RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1277
Practice Address - Country:US
Practice Address - Phone:630-393-3045
Practice Address - Fax:630-393-3920
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-023251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist