Provider Demographics
NPI:1881112639
Name:MALECKI, JOSEPH JR
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:MALECKI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 W GALENA BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4482
Mailing Address - Country:US
Mailing Address - Phone:630-892-7041
Mailing Address - Fax:
Practice Address - Street 1:1940 W GALENA BLVD STE 3
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4482
Practice Address - Country:US
Practice Address - Phone:630-892-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2019-01-11
Deactivation Date:2018-04-12
Deactivation Code:
Reactivation Date:2018-07-18
Provider Licenses
StateLicense IDTaxonomies
IL019.0313831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty